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Azadinia F, Kingma I, Mazaheri M. Effect of external lumbar supports on joint position sense, postural control, and postural adjustment: a systematic review. Disabil Rehabil 2023; 45:753-771. [PMID: 35259058 DOI: 10.1080/09638288.2022.2043464] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To review the effects of external lumbar supports on various aspects of sensorimotor function including joint position sense (JPS), postural control, anticipatory postural adjustments (APAs), and compensatory postural adjustments (CPAs). METHODS A systematic literature search was performed in PubMed, EMBASE, Scopus, Ovid, Cochrane library, and Web of Science. Two reviewers selected studies which assessed the effect of lumbosacral orthosis or kinesio-tape on JPS, postural control or APAs/CPAs in subjects with and without low back pain (LBP). The methodological quality of included studies was assessed using a modified version of Downs and Black's checklist. RESULTS Findings demonstrated moderate effects of lumbosacral orthosis on specific aspects of sensorimotor control including JPS and to a lesser extent standing stability. These domains were not or minimally affected by application of kinesio-tape. Both orthosis and kinesio-tape had negligible effects on APAs and CPAs. CONCLUSIONS The positive effects of lumbar orthosis on JPS or postural control were mostly observed in conditions where sources of proprioceptive feedback are impaired (such as LBP) or absent (standing with eyes closed on an unstable surface). However, evidence does not prove significant positive effects for the application of kinesio-tape to improve sensorimotor control.IMPLICATIONS FOR REHABILITATIONWearing lumbar orthosis leads to an improvement in joint position sense.Postural stability seems to be affected to some extent by utilizing lumbar orthosis.Clinicians can administer orthosis to improve sensorimotor adaptation, especially in conditions with poor proprioception.Kinesio-tape had negligible effects on all domains of sensorimotor control.Improvement of sensorimotor function as a result of application of kinesio-tape is questionable.
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Affiliation(s)
- Fatemeh Azadinia
- School of Rehabilitation Sciences, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Masood Mazaheri
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Scherb D, Wartzack S, Miehling J. Modelling the interaction between wearable assistive devices and digital human models-A systematic review. Front Bioeng Biotechnol 2023; 10:1044275. [PMID: 36704313 PMCID: PMC9872199 DOI: 10.3389/fbioe.2022.1044275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Exoskeletons, orthoses, exosuits, assisting robots and such devices referred to as wearable assistive devices are devices designed to augment or protect the human body by applying and transmitting force. Due to the problems concerning cost- and time-consuming user tests, in addition to the possibility to test different configurations of a device, the avoidance of a prototype and many more advantages, digital human models become more and more popular for evaluating the effects of wearable assistive devices on humans. The key indicator for the efficiency of assistance is the interface between device and human, consisting mainly of the soft biological tissue. However, the soft biological tissue is mostly missing in digital human models due to their rigid body dynamics. Therefore, this systematic review aims to identify interaction modelling approaches between wearable assistive devices and digital human models and especially to study how the soft biological tissue is considered in the simulation. The review revealed four interaction modelling approaches, which differ in their accuracy to recreate the occurring interactions in reality. Furthermore, within these approaches there are some incorporating the appearing relative motion between device and human body due to the soft biological tissue in the simulation. The influence of the soft biological tissue on the force transmission due to energy absorption on the other side is not considered in any publication yet. Therefore, the development of an approach to integrate the viscoelastic behaviour of soft biological tissue in the digital human models could improve the design of the wearable assistive devices and thus increase its efficiency and efficacy.
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Oleiwi MA, Shah SZA, Bilal H, Zeb A, Ahmad A, Hegazye FA, Chen H. Efficacy of orthotic support in mitigating low back pain and disability in low back pain sufferers. J Back Musculoskelet Rehabil 2023; 36:1111-1125. [PMID: 37355884 DOI: 10.3233/bmr-220200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND Low back pain (LBP) is a prevalent disabling ailment that affects people all over the world. A wide variety of orthotic designs, ranging from lumbosacral corsets to rigid thermoplastic thoraco-lumbosacral orthosis are used for managing LBP. OBJECTIVE Explore and summarize quality literature on the efficacy of orthotic devices in the management of LBP. METHODS A systematic review and meta-analysis of the literature on the efficacy of orthosis in low back pain management conducted using electronic databases. Studies utilizing orthotic management alone or combined with other therapies for 2 weeks or above were included. A meta-analysis was performed on primary and secondary variables using Mean difference (MD), Inverse variance (IV), and fixed effect model with 95% CI, Physiotherapy Evidence Database (PEDro) scale, Cochrane Risk of Bias 2 (RoB2) tool were used to assess the quality of evidence and the risk bias. RESULTS Out of 14671 studies, only 13 Randomized Controlled Trials (RCT) were deemed eligible for inclusion in this study, all level 1 evidence. We found that orthotics could significantly mitigate LBP (P-value < 0.00001). Similarly, a significant reeducation in LBP-associated disability was observed after orthotic intervention (P-value 0.004). CONCLUSION Lumber orthosis plays a significant role in LBP and associated disability mitigations in sufferers of LBP.
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Affiliation(s)
- Malik Abdulkadhim Oleiwi
- Department of Rehabilitation Medicine and Physical Therapy, Institute of Medical Technology, Middle Technical University, Baghdad, Iraq
| | - Sayed Zulfiqar Ali Shah
- TopSupport International Sports Performance and Rehabilitation Center, Shenzhen, Guangdong, China
- Department of Rehabilitation Medicine and Physical Therapy, Institute of Medical Technology, Middle Technical University, Baghdad, Iraq
| | - Hazrat Bilal
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Alam Zeb
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Ashfaq Ahmad
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Hong Chen
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Classification of human movements with and without spinal orthosis based on surface electromyogram signals. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Revisiting the lumbosacral orthosis from the perspective of dynamical systems theory: a preliminary randomized clinical trial on patients with chronic low back pain. Prosthet Orthot Int 2021; 45:328-335. [PMID: 34127624 DOI: 10.1097/pxr.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The prevalent method for investigating the effect of therapeutic interventions on walking in the individuals with chronic low back pain (CLBP) is component-level approach in which all measurements focus on the spine component alone. However, this approach cannot disclose information about the overall function of the movement system such as complex walking patterns, which, in turn, reveal the underlying movement control. OBJECTIVES To compare the effect of 3-week wearing of lumbosacral orthosis (LSO) along with routine physical therapy with routine physical therapy alone on walking complexity in the individuals with nonspecific CLBP on the basis of the systems approach. STUDY DESIGN Preliminary randomized clinical trial. METHODS Twenty-four subjects were randomly allocated to two groups. The control group received the routine physical therapy for 3 weeks. The intervention group received the same program plus an LSO. Nonlinear analysis was used to quantify walking complexity, as behavior of the entire movement system, before and after the intervention and at 1-month follow-up. RESULTS An average of 496 strides during ten minutes of walking was used for analysis. There was no significant difference (p > 0.05) in degree of walking complexity between two groups during all evaluation periods. CONCLUSIONS The administered orthotic intervention did not alter walking complexity. This suggests that therapeutic goal of current LSOs, which is not based on the systems approach, cannot recover the emergent behavior of the movement system. This may be a potential source of controversies. CLINICAL RELEVANCE To achieve an effective treatment, orthotists should focus on the individuals themselves, not only on their CLBP symptoms. Although the component-level approach aims to decrease the symptoms, the systems approach focuses on the whole context that fosters LBP symptoms.
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Ikeda H, Miyamori T, Katsuhira J, Sawa R, Shimasaki Y, Takazawa Y, Yoshimura M. Effects of a wearable device and functional wear on spinal alignment and jump performance. J Exerc Sci Fit 2020; 19:91-97. [PMID: 33343670 PMCID: PMC7736979 DOI: 10.1016/j.jesf.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/03/2020] [Accepted: 10/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background/objective To elucidate the effects of walking exercise using a wearable device and functional wear on spinal alignment and jump performance. Methods In total, 27 female college soccer players were randomly divided into two groups: trunk solution (TS) and compression garments (CGs). Spinal alignment, jump performance, and electromyography activity during the jump performance of the two groups were measured after a 20-min walking exercise. The values for each group were compared t pre- and post-intervention. Results The flexibility of the lower thoracic vertebrae in spinal alignment was increased during extension in the TS group. However, the post-value of the abdominal external oblique muscle during a countermovement jump (CMJ) was significantly lower than its pre-value (p < 0.05). In addition, even though spinal alignment was not affected in the CG group, post-values of the jump height during squat jump and CMJ were significantly higher than their pre-values (p < 0.05). Furthermore, the post-value of the biceps femoris during the countermovement jump with arm was significantly lower than its pre-value (p < 0.05). Conclusion Our study suggested that walking exercise using TS may increase the range of motion of the lower thoracic vertebrae in athletes and reduce the muscular activity of the vastus lateralis during CMJ. Additionally, although spinal aliment is not affected, the jump height may increase using CGs.
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Affiliation(s)
- Hayato Ikeda
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Takayuki Miyamori
- Faculty of Health and Sports Science, Juntendo University, Japan.,Department of Health Science, School of Physiotherapy, Juntendo University, Japan
| | | | - Ryuichi Sawa
- Department of Health Science, School of Physiotherapy, Juntendo University, Japan
| | - Yu Shimasaki
- Faculty of Health and Sports Science, Juntendo University, Japan
| | - Yuji Takazawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan.,Faculty of Health and Sports Science, Juntendo University, Japan
| | - Masafumi Yoshimura
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan.,Faculty of Health and Sports Science, Juntendo University, Japan
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Maintaining Lumbar Spine Stability: A Study of the Specific and Combined Effects of Abdominal Activation and Lumbosacral Orthosis on Lumbar Intrinsic Stiffness. J Orthop Sports Phys Ther 2019; 49:262-271. [PMID: 30658047 DOI: 10.2519/jospt.2019.8565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Two potential interventions for enhancing lumbar stability are to actively increase abdominal muscle activity, either through the abdominal drawing-in maneuver (ADIM) or bracing, and passively increase lumbar stiffness using a lumbosacral orthosis (LSO). OBJECTIVE To compare the increase in lumbar stiffness after 2 active interventions (ADIM versus bracing) and 1 passive intervention (LSO), and to evaluate the combined effect of active (abdominal bracing) and passive interventions. METHODS In this experimental and comparative study, lumbar stiffness, a surrogate measure of lumbar stability, was estimated in 25 healthy individuals during 7 trunk perturbation conditions: (1) control, (2) ADIM, (3) bracing at 5% of right external oblique maximal voluntary activation (5% bracing), (4) bracing at 10% of right external oblique maximal voluntary activation (10% bracing), (5) LSO, (6) LSO plus 5% bracing, and (7) LSO plus 10% bracing. Electromyographic biofeedback of the external oblique was provided on a monitor, while ultrasound was used for the ADIM to ensure a sustained contraction of the transversus abdominis. RESULTS The ADIM, 5% bracing, and 10% bracing active interventions generated comparable lumbar stiffness. However, considering that bracing can range from 10% to 20%, it may be superior to hollowing, as further estimated with a mixed-effect statistical model. Combining bracing and an LSO resulted in an additive effect on lumbar stiffness. CONCLUSION Bracing and ADIM produced comparable lumbar stiffness, as they were performed at the same overall abdominal activation levels (5% and 10% maximal voluntary activation). The independent effects of bracing and LSO raises the possibility of combining these interventions in some circumstances. J Orthop Sports Phys Ther 2019;49(4):262-271. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8565.
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Schott C, Zirke S, Schmelzle JM, Kaiser C, Fernández LAI. Effectiveness of lumbar orthoses in low back pain: Review of the literature and our results. Orthop Rev (Pavia) 2018; 10:7791. [PMID: 30662686 PMCID: PMC6315306 DOI: 10.4081/or.2018.7791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/09/2018] [Indexed: 11/23/2022] Open
Abstract
Back pain and diseases of the spine are today a health disorder of outstanding epidemiological, medical, and health economic importance. The cost of care for patients with lumbosciatic complaints are steadily increasing. Accordingly, the guidelines and treatments are constantly renewed. One concept is the orthotic care. In the following we want to give an overview of the literature and the effectiveness of lumbar orthoses in low back pain supplemented by our own data. A prospective randomized study with 230 patients, divided into three groups, each with two subgroups. Three Orthoses by the TIGGES-Zours GmbH were prescribed; a demountable two-step lumbar orthosis, three-step bridging orthosis and a four-step flexion orthosis modular system. Each were compared to the nonmodular equivalent. All six groups showed improvement in pain intensity and functional capacity at 6 and 12 weeks. The modular groups were found to have improvement in the frequency of use. The subjective effectiveness and sensitivity for the modular and non-modular groups was assessed as being good. In the literature, there are no clear guidelines for an orthotic supply. The studies do not seem to be meaningful and universal due to the difficult ascertainability of pain. There is a need for further research here. Nevertheless, the authors of this review are of the opinion that the implementation of trunk orthoses is void of side effects and beneficial to patients. The modular systems seem to have an advantage as well as higher patient satisfaction.
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Affiliation(s)
| | - Sonja Zirke
- Institut für Wirbelsäulenforschung, Bochum, Germany
| | | | - Christel Kaiser
- Department of Orthopedics and Trauma Surgery, University Hospital, Essen, Germany
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Mahmood MN, Peeters LHC, Paalman M, Verkerke GJ, Kingma I, van Dieën JH. Development and evaluation of a passive trunk support system for Duchenne muscular dystrophy patients. J Neuroeng Rehabil 2018. [PMID: 29540235 PMCID: PMC5853074 DOI: 10.1186/s12984-018-0353-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Patients with Duchenne muscular dystrophy gradually lose the ability to use different muscles of their body. Consequently, they lose the ability to stabilize their trunk against gravity. This hinders them to effectively perform different daily activities. In this paper, we describe the design, realization and evaluation of a trunk orthosis for these patients that should allow them to move their trunk and maintain stability. Method This study aimed to primarily assess the effectiveness of the trunk support system in terms of unloading of trunk muscles, so only healthy participants were recruited for this phase of the study. Measurements were done on 10 healthy participants (23.4±2.07 [M±SD] years old, average body weight 68.42±24.22 [M±SD] kg). The experiment comprised maintaining a constant trunk posture in three different device conditions (control without orthosis and two conditions with different configurations of the orthosis), at four different flexion angles (10°, 20°, 30°, 40°) for each device condition and for two load conditions (with and without stretching the arms). Electromyography (EMG) signals from the trunk muscles were measured to estimate activation levels of the trunk muscles (iliocostalis, longissimus, external oblique and rectus abdominis) and a motion capture system was used to record the movement of the participants during the experiment. Results Wearing the orthosis caused reductions in longissimus and iliocostalis activity. The average muscle activity level was 5%–10% of maximum voluntary contraction in the unsupported conditions for those particular muscles. This level was reduced to 3%–9% of maximal voluntary contraction for the supported conditions. No effect on external oblique and rectus abdominis activity was observed. Moreover, no pain or discomfort was reported by any of the participants during the experiment. The results from the current experiment also suggests the necessity of lumber stabilizing systems while using trunk orthosis. Conclusion The developed orthosis reduces trunk muscle activation level and provides a solid step for further development of support systems for Duchenne muscular dystrophy patients. Trial registration The current study was approved by the medical ethics committee Arnhem-Nijmegen (study number: NL53143.091.15), The Netherlands.
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Affiliation(s)
| | - Laura H C Peeters
- Dept of Rahabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Micha Paalman
- Dept of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gijsbertus J Verkerke
- Dept of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,dept of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Idsart Kingma
- Dept of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Jaap H van Dieën
- Dept of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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10
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Mi J, Ye J, Zhao X, Zhao J. Effects of lumbosacral orthoses on postural control in individuals with or without non-specific low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:180-186. [PMID: 29071410 DOI: 10.1007/s00586-017-5355-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the effect of lumbosacral orthoses (LSOs) on postural control in individuals with or without non-specific low back pain (NSLBP). METHODS Individuals with NSLBP (n = 28) and healthy controls (n = 28) were enrolled to assess the postural control with or without LSOs. Postural control was tested using the Balance Master® NeuroCom system by the modified clinical test of sensory interaction and balance. RESULTS Relative to controls, patients with NSLBP had deficits in postural control with greater center of pressure (COP) sway velocity when standing on firm surface (with eyes open: p = 0.002; with eyes closed: p = 0.002) and standing on foam surface (with eyes open: p = 0.024; with eyes closed: p < 0.001). In the braced condition, the COP sway decreased in all subjects with or without NSLBP when standing on foam surface. There was no significant difference in the effect of LSOs on postural control between NSLBP group and healthy controls. CONCLUSION Individuals with NSLBP have poorer postural control than controls. LSOs seem to improve postural control when standing on unstable surfaces in subjects with or without NSLBP. The effect of LSOs on postural control may not depend on the level of baseline.
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Affiliation(s)
- Jie Mi
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jiling Ye
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xin Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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11
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Azadinia F, Ebrahimi E, Kamyab M, Parnianpour M, Cholewicki J, Maroufi N. Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. Spine J 2017; 17:589-602. [PMID: 27988341 DOI: 10.1016/j.spinee.2016.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/14/2016] [Accepted: 12/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Wearing lumbosacral orthosis (LSO) is one of the most common treatments prescribed for conservative management of low back pain. Although the results of randomized controlled trials suggest effectiveness of LSO in reducing pain and disability in these patients, there is a concern that prolonged use of LSO may lead to trunk muscle weakness and atrophy. PURPOSE The present review aimed to evaluate available evidence in literature to determine whether LSO results in trunk muscle weakness or atrophy. STUDY DESIGN This is a systematic review. METHODS A systematic search of electronic databases including PubMed, Scopus, ScienceDirect, and Medline (via Ovid) followed by hand search of journals was performed. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the effect of lumbar orthosis on trunk muscle activity, muscle thickness, strength or endurance, spinal force, and intra-abdominal pressure in healthy subjects or in patients with low back pain, were included. Methodological quality of selected studies was assessed by using the modified version of Downs and Black checklist. This research had no funding source, and the authors declare no conflicts of interest-associated biases. RESULTS Thirty-five studies fulfilled the eligibility criteria. The mean and standard deviation of the quality score was 64±9.7%. Most studies investigating the effect of lumbar orthosis on electromyographic activity (EMG) of trunk muscles demonstrated a decrease or no change in the EMG parameters. A few studies reported increased muscle activity. Lumbosacral orthosis was found to have no effect on muscle strength in some studies, whereas other studies demonstrated increased muscle strength. Only one study, which included ultrasound assessment of trunk muscle stabilizers, suggested reduced thickness of the abdominal muscles and reduced cross-sectional area of the multifidus muscles. Out of eight studies that investigated spinal compression load, the load was reduced in four studies and unchanged in three studies. One study showed that only elastic belts reduced compression force compared to leather and fabric belts and ascribed this reduction to the elastic property of the lumbar support. CONCLUSION The present review showed that the changes in outcome measures associated with muscle work demands were inconsistent in their relation to the use of lumbar supports. This review did not find conclusive scientific evidence to suggest that orthosis results in trunk muscle weakness.
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Affiliation(s)
- Fatemeh Azadinia
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Ebrahimi
- Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Parnianpour
- Biomechanics Laboratory, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Jacek Cholewicki
- MSU Center for Orthopedic Research, Department of Surgical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Nader Maroufi
- Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Morrison S, Russell DM, Kelleran K, Walker ML. Bracing of the trunk and neck has a differential effect on head control during gait. J Neurophysiol 2015; 114:1773-83. [PMID: 26180113 DOI: 10.1152/jn.00059.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/09/2015] [Indexed: 11/22/2022] Open
Abstract
During gait, the trunk and neck are believed to play an important role in dissipating the transmission of forces from the ground to the head. This attenuation process is important to ensure head control is maintained. The aim of the present study was to assess the impact of externally restricting the motion of the trunk and/or neck segments on acceleration patterns of the upper body and head and related trunk muscle activity. Twelve healthy adults performed three walking trials on a flat, straight 65-m walkway, under four different bracing conditions: 1) control-no brace; 2) neck-braced; 3) trunk-braced; and 4) neck-trunk braced. Three-dimensional acceleration from the head, neck (C7) and lower trunk (L3) were collected, as was muscle activity from trunk. Results revealed that, when the neck and/or trunk were singularly braced, an overall decrease in the ability of the trunk to attenuate gait-related oscillations was observed, which led to increases in the amplitude of vertical acceleration for all segments. However, when the trunk and neck were braced together, acceleration amplitude across all segments decreased in line with increased attenuation from the neck to the head. Bracing was also reflected by increased activity in erector spinae, decreased abdominal muscle activity and lower trunk muscle coactivation. Overall, it would appear that the neuromuscular system of young, healthy individuals was able to maintain a consistent pattern of head acceleration, irrespective of the level of bracing, and that priority was placed over the control of vertical head accelerations during these gait tasks.
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Affiliation(s)
- S Morrison
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia; and
| | - D M Russell
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia; and
| | - K Kelleran
- Human Movement Sciences Department, Old Dominion University, Norfolk, Virginia
| | - M L Walker
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia; and
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Morrisette DC, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of lower back pain. Spine (Phila Pa 1976) 2014; 39:1733-42. [PMID: 25054648 PMCID: PMC4521401 DOI: 10.1097/brs.0000000000000521] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Single blinded, randomized clinical trial for the evaluation of lumbosacral orthoses (LSOs) in the management of lower back pain (LBP). OBJECTIVE To evaluate the effects of two types of LSOs on self-rated disability in patients with LBP. SUMMARY OF BACKGROUND DATA LSOs are commonly used for the management of LBP, but their effectiveness may vary because of design. An inextensible LSO (iLSO) reduces trunk motion and increases trunk stiffness, whereas an extensible LSO (eLSO) does not. METHODS A total of 98 participants with LBP were randomized to 3 groups: (1) standard care (SC) group, which included medication and physical therapy (n = 29), (2) SC with eLSO (eLSO group) (n = 32), and (3) SC with iLSO (iLSO group) (n = 37). Outcome measures were evaluated before and after 2 weeks of treatment: modified Oswestry Disability Index (ODI), Patient Specific Activity Scale, pain ratings, and Fear Avoidance Beliefs Questionnaire. RESULTS There were no statistically significant differences between groups at baseline. Compared with the SC alone, iLSO group showed greater improvement on the ODI scores (P = 0.01) but not the eLSO group. The ODI scores improved by a mean of 2.4 (95% confidence interval [CI], 2.2-7.1), 8.1 (95% CI, 2.8-13.4), and 14.0 (95% CI, 8.2-19.8) points for SC, eLSO, and iLSO groups, respectively. Individuals wearing the iLSO had 4.7 times higher odds of achieving 50% or greater improvement in the ODI scores than those assigned to SC (95% CI, 1.2-18.5, P = 0.03). Both the eLSO and iLSO groups had a greater improvement in the Patient Specific Activity Scale scores than the SC group (P = .05 and P = 0.01, respectively), but the change did not meet the minimal clinically important difference. Pain ratings improved for all 3 groups, with no statistical difference between them. Finally, no significant differences across groups were found for the Fear Avoidance Beliefs Questionnaire. CONCLUSION An iLSO led to greater improvement in ODI scores than SC and an eLSO. We surmise that the likely mechanism responsible for this difference in outcome was the added trunk stiffness and motion restriction by the iLSO. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- David C Morrisette
- *Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston †Center for Orthopedic Research, Osteopathic Surgical Specialties, College of Osteopathic Medicine, Michigan State University, East Lancing ‡Family Services Research Center, Medical University of South Carolina, Charleston §Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston; and ¶Department of Physical Therapy, Medical University of South Carolina Hospital Authority, Charleston
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Dailey AT, Ghogawala Z, Choudhri TF, Watters WC, Resnick DK, Sharan A, Eck JC, Mummaneni PV, Wang JC, Groff MW, Dhall SS, Kaiser MG. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: brace therapy as an adjunct to or substitute for lumbar fusion. J Neurosurg Spine 2014; 21:91-101. [PMID: 24980591 DOI: 10.3171/2014.4.spine14282] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The utilization of orthotic devices for lumbar degenerative disease has been justified from both a prognostic and therapeutic perspective. As a prognostic tool, bracing is applied prior to surgery to determine if immobilization of the spine leads to symptomatic relief and thus justify the performance of a fusion. Since bracing does not eliminate motion, the validity of this assumption is questionable. Only one low-level study has investigated the predictive value of bracing prior to surgery. No correlation between response to bracing and fusion outcome was observed; therefore a trial of preoperative bracing is not recommended. Based on low-level evidence, the use of bracing is not recommended for the prevention of low-back pain in a general working population, since the incidence of low-back pain and impact on productivity were not reduced. However, in laborers with a history of back pain, a positive impact on lost workdays was observed when bracing was applied. Bracing is recommended as an option for treatment of subacute low-back pain, as several higher-level studies have demonstrated an improvement in pain scores and function. The use of bracing following instrumented posterolateral fusion, however, is not recommended, since equivalent outcomes have been demonstrated with or without the application of a brace.
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Affiliation(s)
- Andrew T Dailey
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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15
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Muscle Contributions to L4-5 Joint Rotational Stiffness following Sudden Trunk Flexion and Extension Perturbations. J Med Eng 2013; 2013:915428. [PMID: 27006926 PMCID: PMC4782634 DOI: 10.1155/2013/915428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/28/2012] [Accepted: 12/06/2012] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to investigate the contribution of individual muscles (MJRSm) to total joint rotational stiffness (MJRST) about the lumbar spine's L4-5 joint prior to, and following, sudden dynamic flexion or extension perturbations to the trunk. We collected kinematic and surface electromyography (sEMG) data while subjects maintained a kneeling posture on a parallel robotic platform, with their pelvis constrained by a harness. The parallel robotic platform caused sudden inertial trunk flexion or extension perturbations, with and without the subjects being aware of the timing and direction. Prevoluntary muscle forces incorporating both short and medium latency neuromuscular responses contributed significantly to joint rotational stiffness, following both sudden trunk flexion and extension motions. MJRST did not change with perturbation direction awareness. The lumbar erector spinae were always the greatest contributor to MJRST. This indicates that the neuromuscular feedback system significantly contributed to MJRST, and this behaviour likely enhances joint stability following sudden trunk flexion and extension perturbations.
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Individual muscle contributions to knee joint impedance following a sudden perturbation: An in vivo inverted pendulum model. J Electromyogr Kinesiol 2011; 22:243-50. [PMID: 22138272 DOI: 10.1016/j.jelekin.2011.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/04/2011] [Indexed: 11/23/2022] Open
Abstract
Previous research has suggested that muscle forces, generated by reflexes, contribute to joint stability prior to the more coordinated voluntary muscle forces. The purpose of the current study was to quantify the behaviour of the leg muscles, through the calculation of individual muscle contributions to joint rotational impedance (MJRI), with a specific interest in the neuromuscular contribution in the period following shortly after a sudden knee extension perturbation. The knee was selected as an in vivo system to represent an inverted pendulum model. Kinematic and sEMG data were collected while subjects were in a prone position and exposed to sudden knee extension perturbations. A biomechanical model was used to estimate muscle forces and moments about the knee and these data were then used to calculate instantaneous MJRI. Data indicated that pre-voluntary muscle forces do contribute significantly to MJRI following a sudden knee extension perturbation as there was a 40% increase in total MJRI in the flexion/extension and valgus/varus axes immediately following the perturbation, suggesting their importance in stabilizing the joint immediately after a disturbance. Additionally, knowledge of perturbation timing was shown to increase anticipatory MJRI levels, pre-perturbation (p<0.05), indicating that it is advantageous for the neuromuscular system to prepare for a sudden disturbance. In conclusion, the data show that the neuromuscular feedback system significantly contributes to MJRI and it is believed that this behaviour enhances joint impedance following a sudden knee extension perturbation.
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Mathias M, Rougier PR. In healthy subjects, the sitting position can be used to validate the postural effects induced by wearing a lumbar lordosis brace. Ann Phys Rehabil Med 2010; 53:511-9. [PMID: 20851078 DOI: 10.1016/j.rehab.2010.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 07/14/2010] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
Abstract
AIM OF THE STUDY To assess the validity of the sitting position when testing lumbar braces for the maintenance of lordosis. PATIENTS AND METHODS Twelve young adult subjects participated in the experiment, in which they were seated on force platform. The four experimental conditions (with or without a brace and with or without enforced lordosis) were chosen in order to distinguish between the roles played by lordosis and the brace, respectively. The trajectories of the centre of pressure (CP) were analyzed and compared, in order to assess postural orientation and stabilisation processes. RESULTS Although no effect was seen in terms of orientation, our data showed that use of a lumbar brace led to a notable reduction in CP displacement along the mediolateral and anteroposterior axes. Lordosis barely affected postural performance and only an increase in the mean CP velocity was observed. Lastly, an analysis of variance failed to reveal an interaction between the "lordosis" and "brace" factors. CONCLUSION A lumbar brace (in the absence or presence of lordosis) helps subjects to improve their sitting performance. In contrast to previous studies based on the standing posture, the fact that significant differences were found as a function of brace wear emphasises the discriminant power of the sitting position. This task should therefore be applied more widely in the development of more appropriate, validated equipment for lower back pain sufferers.
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Affiliation(s)
- M Mathias
- EA 4338, laboratoire de physiologie de l'exercice, université de Savoie, domaine universitaire de Savoie-Technolac, 73376 Le-Bourget-du-Lac cedex, France
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Cholewicki J, McGill KC, Shah KR, Lee AS. The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations. BMC Musculoskelet Disord 2010; 11:154. [PMID: 20609255 PMCID: PMC2912792 DOI: 10.1186/1471-2474-11-154] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 07/07/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effects of lumbosacral orthoses (LSOs) on neuromuscular control of the trunk are not known. There is a concern that wearing LSOs for a long period may adversely alter muscle control, making individuals more susceptible to injury if they discontinue wearing the LSOs. The purpose of this study was to document neuromuscular changes in healthy subjects during a 3-week period while they regularly wore a LSO. METHODS Fourteen subjects wore LSOs 3 hrs a day for 3 weeks. Trunk muscle activity prior to and following a quick force release (trunk perturbation) was measured with EMG in 3 sessions on days 0, 7, and 21. A longitudinal, repeated-measures, factorial design was used. Muscle reflex response to trunk perturbations, spine compression force, as well as effective trunk stiffness and damping were dependent variables. The LSO, direction of perturbation, and testing session were the independent variables. RESULTS The LSO significantly (P < 0.001) increased the effective trunk stiffness by 160 Nm/rad (27%) across all directions and testing sessions. The number of antagonist muscles that responded with an onset activity was significantly reduced after 7 days of wearing the LSO, but this difference disappeared on day 21 and is likely not clinically relevant. The average number of agonist muscles switching off following the quick force release was significantly greater with the LSO, compared to without the LSO (P = 0.003). CONCLUSIONS The LSO increased trunk stiffness and resulted in a greater number of agonist muscles shutting-off in response to a quick force release. However, these effects did not result in detrimental changes to the neuromuscular function of trunk muscles after 3 weeks of wearing a LSO 3 hours a day by healthy subjects.
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Affiliation(s)
- Jacek Cholewicki
- Department of Surgical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
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Cholewicki J, Lee AS, Reeves NP, Morrisette DC. Comparison of trunk stiffness provided by different design characteristics of lumbosacral orthoses. Clin Biomech (Bristol, Avon) 2010; 25:110-4. [PMID: 20004503 PMCID: PMC2887766 DOI: 10.1016/j.clinbiomech.2009.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 10/15/2009] [Accepted: 10/20/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbosacral orthoses (LSOs) are class I medical devices that are used in conservative and postoperative management of low back pain. The effectiveness of LSOs depends on their design aimed at enhancing trunk stiffness. Therefore, the purpose of this study was to compare two lumbar supports: extensible (made of neoprene and lycra) and non-extensible (made of polyester and nylon). METHODS Trunk stiffness and damping was estimated from trunk displacement data in response to a quick force release in trunk flexion, extension, and lateral bending. Fourteen male and 6 female subjects performed five trials at each experimental condition: (1) No LSO, (2) extensible LSO, (3) non-extensible LSO, (4) non-extensible LSO with a small rigid front panel, and (5) non-extensible LSO with a large rigid front panel. Testing order was randomized and the LSOs were cinched to a pressure of 70 mmHg (9.4 kPa) measured between posterior aspect of the iliac crest and the orthosis. FINDINGS The non-extensible LSO reduced trunk displacement by 14% and increased trunk stiffness by 14% (P<0.001). The extensible LSO did not result in any significant change in trunk displacement or stiffness. The addition of rigid front panels to the non-extensible LSO did not improve its effectiveness. The trunk damping did not differ between the LSO conditions. INTERPRETATION A non-extensible LSO is more effective in augmenting trunk stiffness and limiting trunk motion following a perturbation than an extensible LSO. The rigid front panels do not provide any additional trunk stiffness most likely due to incongruence created between the body and a brace.
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Affiliation(s)
- Jacek Cholewicki
- Michigan State University Center for Orthopaedic Research, Department of Surgical, Specialties, College of Osteopathic Medicine, Ingham Regional Orthopedic Hospital, 2727 S., Pennsylvania Avenue, Lansing, MI 48910 USA,Corresponding author
| | - Angela S. Lee
- Michigan State University Center for Orthopaedic Research, Department of Surgical, Specialties, College of Osteopathic Medicine, Ingham Regional Orthopedic Hospital, 2727 S., Pennsylvania Avenue, Lansing, MI 48910 USA
| | - N. Peter Reeves
- Michigan State University Center for Orthopaedic Research, Department of Surgical, Specialties, College of Osteopathic Medicine, Ingham Regional Orthopedic Hospital, 2727 S., Pennsylvania Avenue, Lansing, MI 48910 USA
| | - David C. Morrisette
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Ippolito E, Versari P, Lezzerini S. The role of rehabilitation in juvenile low back disorders. ACTA ACUST UNITED AC 2009; 9:174-84. [PMID: 17050395 DOI: 10.1080/13638490500158031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Both children and adolescents are frequently affected by low back pain--mainly when they are involved in sporting activities--but they rarely ask for medical help, because their symptoms are often mild and self-resolving. However, in the young patients who seek orthopaedic evaluation, especially in referral centres, there is a high incidence of organic causes of their back pain. Mechanical, developmental, inflammatory and tumoural or tumour-like disorders are the most frequent aetiologic factors. A diagnosis of psychosomatic back pain should be made only when all the other possible organic causes have been excluded. Rehabilitation is part of the treatment of low back disorders in children and adolescents. Postural low back pain is likely to be resolved by physical therapy alone. In other disorders that initially require medical, orthotic or surgical treatment, rehabilitation plays an important role either in combination with them or as a subsequent treatment.
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Affiliation(s)
- E Ippolito
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Roma, Italy.
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Abstract
Wrist splints are commonly prescribed to limit wrist motion and provide support at night and during inactive periods but are often used in the workplace. In theory, splinting the wrist should reduce wrist extensor muscle activity by stabilizing the joint and reducing the need for co-contraction to maintain posture. Ten healthy volunteers underwent a series of 24 10-s gripping trials with surface electromyography on 6 forearm muscles. Trials were randomized between splinted and nonsplinted conditions with three wrist postures (30 degrees flexion, neutral, and 30 degrees extension) and four grip efforts. Custom-made Plexiglas splints were taped to the dorsum of the hand and wrist. It was found that when simply holding the dynamometer, use of a splint led to a small (<1% MVE) but significant reduction in activity for all flexor muscles and extensor carpi radialis (all activity <4% maximum). At maximal grip, extensor muscle activity was significantly increased with the splints by 7.9-23.9% MVE. These data indicate that splinting at low-to-moderate grip forces may act to support the wrist against external loading, but appears counterproductive when exerting maximal forces. Wrist bracing should be limited to periods of no to light activity and avoided during tasks that require heavy efforts.
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Trunk muscle response to various protocols of lumbar traction. ACTA ACUST UNITED AC 2008; 14:562-6. [PMID: 18824391 DOI: 10.1016/j.math.2008.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 07/21/2008] [Accepted: 08/03/2008] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to compare trunk muscle activity, spinal decompression force, and trunk flexibility resulting from various protocols of spinal traction. Four experiments explored the effects of (1) sinusoidal, triangular, square, and continuous distraction-force waveforms, (2) 0, 10, 20, and 30 degrees of pull angle, (3) superimposed low, medium and high frequency force oscillations, and (4) sham traction. Nineteen healthy subjects volunteered for this study. Surface EMG was recorded during traction and later used in a biomechanical model to estimate spine decompression force. Trunk flexibility was measured before and after each treatment. There were no differences in muscle activity between any of the experimental conditions except the thoracic erector spinae muscle, which had lower EMG during continuous compared to sinusoidal distraction-force waveform (p=0.02). Thoracic and lumbar erector spinae muscles were significantly less active during sham than real traction (p=0.01 and p=0.04, respectively). The estimated L4-L5 spine compression force was 25N. Trunk flexibility decreased after each experimental session (p=0.01), and there were no differences between sessions. Our results suggest that the trunk muscle activity is minimal and point toward fluid exchange in the disc as one of the key biomechanical effects of spinal traction.
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Cholewicki J, Reeves NP, Everding VQ, Morrisette DC. Lumbosacral orthoses reduce trunk muscle activity in a postural control task. J Biomech 2006; 40:1731-6. [PMID: 17054963 DOI: 10.1016/j.jbiomech.2006.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 08/28/2006] [Indexed: 11/19/2022]
Abstract
Biomechanical modeling estimated that trunk muscle activity during various tasks could be reduced by 1-14% without the loss of spine stability when a lumbosacral orthosis (LSO) is worn [Cholewicki, J., 2004. The effects of lumbosacral orthoses on spine stability: what changes in EMG can be expected? Journal of Orthopedic Research 22, 1150-1155]. The present study experimentally tested these theoretical predictions in an unstable sitting task. This task required subjects to balance on a seat supported by a plastic hemisphere (slashed circle=30cm) and placed on a force plate that tracked the center of pressure (CoP). The average CoP velocity quantified subjects' performance. Healthy subjects (12 males, 11 females) balanced for 20s in 3 trials performed with and without the LSO in random order. EMG was recorded bilaterally from rectus abdominis (RA), external oblique (EO), thoracic (TES) and lumbar erector spinae (LES), and expressed as the % of maximum voluntary activation (%MVA). There was no difference in the balance performance with and without the LSO (p=0.13). However, EMG averaged across the trials was significantly lower in the LSO, as compared to the No LSO condition, for TES (5.8+/-3.2 vs. 6.4+/-3.7%MVA, p=0.02) and LES (3.7+/-1.5 vs. 5.9+/-3.9%MVA, p=0.01). No significant differences were present in the abdominal muscle activity. These results agree with earlier spine modeling simulations, which predicted the greatest reduction in muscle activity due to LSO to occur in TES and LES. It was hypothesized that such a reduction in muscle co-contraction could benefit patients with low back pain, who exhibit elevated muscular activity during postural tasks such as walking, standing and sitting.
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Affiliation(s)
- Jacek Cholewicki
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, P.O. Box 208071, New Haven CT 06520 8071, USA.
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Reeves NP, Everding VQ, Cholewicki J, Morrisette DC. The effects of trunk stiffness on postural control during unstable seated balance. Exp Brain Res 2006; 174:694-700. [PMID: 16724177 DOI: 10.1007/s00221-006-0516-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
This paper focused on the relationship between trunk stiffness and postural control during unstable seated balancing. We hypothesized that an increase in trunk stiffness would degrade postural control, and further hypothesized that signal dependent noise (SDN), resulting in increased muscle force variability, was responsible for this impairment. Ten subjects balanced on an unstable seat during four randomized conditions: normal balancing (control condition), trunk muscle co-activation (active stiffness), arm muscle co-activation (attention control), and belt (passive stiffness). Center of pressure (CoP) and EMG data were collected during three 20 s trials. Postural control was quantified by CoP velocity (total path divided by sample time in seconds). Trunk muscle co-activation resulted in significantly higher CoP velocity than the control (P < 0.001) and arm co-activation (P < 0.001) conditions. EMG data confirmed that the trunk co-activation condition had significantly higher muscle activity than the control (P = 0.001) and arm co-activation (P = 0.001) conditions. The belt condition, which increases passive trunk stiffness, showed no degraded postural control, but interestingly produced slightly lower levels of trunk muscle activity than the control condition (P < 0.001). Increased active trunk stiffness from muscle co-activation degraded postural control. Since the arm co-activation condition showed no impairment, attention demands cannot explain this result. Furthermore, since passive trunk stiffness from wearing a belt did not affect performance, it is believed that SDN from increased trunk muscle recruitment, and not an altered postural control strategy from increased joint stiffness, was responsible for the impairment.
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Affiliation(s)
- N Peter Reeves
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA
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