Estimation of trunk muscle forces and spinal loads during fatiguing repetitive trunk exertions

Effect of muscular fatigue on the cumulative lumbar damage during repetitive lifting task: a comparative study of damage calculation methods

Several methods have been put forward to quantify cumulative loads; however, limited evidence exists as to the subsequent damages and the role of muscular fatigue. The present study assessed whether muscular fatigue could affect cumulative damage imposed on the L5-S1 joint. Trunk muscle electromyographic (EMG) activities and kinematics/kinetics of 18 healthy male individuals were evaluated during a simulated repetitive lifting task. A traditional EMG-assisted model of the lumbar spine was modified to account for the effect of erector spinae fatigue. L5-S1 compressive loads for each lifting cycle were estimated based on varying (i.e. actual), fatigue-modified, and constant Gain factors. The corresponding damages were integrated to calculate the cumulative damage. Moreover, the damage calculated for one lifting cycle was multiplied by the lifting frequency, as the traditional approach. Compressive loads and the damages obtained through the fatigue-modified model were predicted in close agreement with the actual values. Similarly, the difference between actual damages and those driven by the traditional approach was not statistically significant (p = 0.219). However, damages based on a constant Gain factor were significantly greater than those based on the actual (p = 0.012), fatigue-modified (p = 0.017), and traditional (p = 0.007) approaches.Practitioner summary: In this study, we managed to include the effect of muscular fatigue on cumulative lumbar damage calculations. Including the effect of muscular fatigue leads to an accurate estimation of cumulative damages while eliminating computational complexity. However, using the traditional approach also appears to provide acceptable estimates for ergonomic assessments.

Evaluation of the lumbar and abdominal muscles behavior in different sagittal plane angles during maximum voluntary isometric extension

Physical positions and lumbar movements are directly related to lumbar disorders. It is known that the sagittal plane angle affects the person's ability to apply extension torque. However, there is no consensus on whether or not muscle activity and co-contractions change at these angles. This paper aimed to investigate the abdominal and lumbar muscles' behavior at different sagittal plane angles during maximum voluntary isometric extension (MVIE). We have evaluated our findings with the aid of a computational biomechanical model. Fourteen healthy males participated. A total of 16 muscles EMG were recorded during the lumbar MVIE on the Sharif Lumbar Isometric Strength Tester device in 5°, 15°, 30°, and 45° flexion. The torque and muscle activity changes and all co-contraction indexes (CCI) between 120 possible muscle pairs were calculated. Finally, the experimental test conditions were modeled in the AnyBody software, and the MVIE torque, muscle activity, and all CCIs were calculated. Also, muscle torque lever arms were calculated at different angles. Results show that MVIE at four angles is 137.94 ± 36.08, 148.63 ± 47.96, 168.09 ± 50.48, and 171.44 ± 53.95 N · m, respectively. Muscle activity and CCI are similar at all angles. The AnyBody model gives similar findings. Muscles torque lever arms change with angle. In conclusion, to determine the safety mode of lifting in the sagittal plane, it seems that the torque differences are due to changes in the geometrical muscle parameters (including the torque lever arm). Despite the almost constant muscular effort, subjects in the 30°-45° bending positions can apply more MVIE.

The effect of back muscle fatigue on EMG and kinematics based estimation of low-back loads and active moments during manual lifting tasks

This study investigated the effects of back muscle fatigue on the estimation of low-back loads and active low-back moments during lifting, using an EMG and kinematics based model calibrated with data from an unfatigued state. Fourteen participants performed lifting tasks in unfatigued and fatigued states. Fatigue was induced through semi-static forward bending. EMG, kinematics, and ground reaction forces were measured, and low-back loads were estimated using inverse dynamics and EMG-driven muscle model. A regression model was developed using data from a set of calibration lifts, and its accuracy was evaluated for unfatigued and fatigued lifts. During the fatigue-inducing task, the EMG amplitude increased by 2.8 %MVC, representing a 38% increase relative to the initial value. However, during the fatigued lifts, the peak EMG amplitude was found to be 1.6 %MVC higher than that observed during the unfatigued lifts, representing a mere 4% increase relative to the baseline unfatigued peak EMG amplitude. Kinematics and low-back load estimates remained unaffected. Regression model estimation errors remained unaffected for 5 kg lifts, but increased by no more than 5% of the peak active low-back moment for 15 kg lifts. We conclude that the regression-based estimation quality of active low-back moments can be maintained during periods of muscle fatigue, although errors may slightly increase for heavier loads.

A Comprehensive Evaluation of Spine Kinematics, Kinetics, and Trunk Muscle Activities During Fatigue-Induced Repetitive Lifting

OBJECTIVE

Spine kinematics, kinetics, and trunk muscle activities were evaluated during different stages of a fatigue-induced symmetric lifting task over time.

BACKGROUND

Due to neuromuscular adaptations, postural behaviors of workers during lifting tasks are affected by fatigue. Comprehensive aspects of these adaptations remain to be investigated.

METHOD

Eighteen volunteers repeatedly lifted a box until perceived exhaustion. Body center of mass (CoM), trunk and box kinematics, and feet center of pressure (CoP) were estimated by a motion capture system and force-plate. Electromyographic (EMG) signals of trunk/abdominal muscles were assessed using linear and nonlinear approaches. The L5-S1 compressive force (Fc) was predicted via a biomechanical model. A two-way multivariate analysis of variance (MANOVA) was performed to examine the effects of five blocks of lifting cycle (C1 to C5) and lifting trial (T1 to T5), as independent variables, on kinematic, kinetic, and EMG-related measures.

RESULTS

Significant effects of lifting trial blocks were found for CoM and CoP shift in the anterior-posterior direction (respectively p < .001 and p = .014), trunk angle (p = .004), vertical box displacement (p < .001), and Fc (p = .005). EMG parameters indicated muscular fatigue with the extent of changes being muscle-specific.

CONCLUSION

Results emphasized variations in most kinematics/kinetics, and EMG-based indices, which further provided insight into the lifting behavior adaptations under dynamic fatiguing conditions.

APPLICATION

Movement and muscle-related variables, to a large extent, determine the magnitude of spinal loading, which is associated with low back pain.

An ergonomic assessment tool for evaluating the effect of back exoskeletons on injury risk

Low back disorders (LBDs) are a leading injury in the workplace. Back exoskeletons (exos) are wearable assist devices that complement traditional ergonomic controls and reduce LBD risks by alleviating musculoskeletal overexertion. However, there are currently no ergonomic assessment tools to evaluate risk for workers wearing back exos. Exo-LiFFT, an extension of the Lifting Fatigue Failure Tool, is introduced as a means to unify the etiology of LBDs with the biomechanical function of exos. We present multiple examples demonstrating how Exo-LiFFT can assess or predict the effect of exos on LBD risk without costly, time-consuming electromyography studies. For instance, using simulated and real-world material handling data we show an exo providing a 30 Nm lumbar moment is projected to reduce cumulative back damage by ∼70% and LBD risk by ∼20%. Exo-LiFFT provides a practical, efficient ergonomic assessment tool to assist safety professionals exploring back exos as part of a comprehensive occupational health program.

Estimation of Trunk Muscle Forces Using a Bio-Inspired Control Strategy Implemented in a Neuro-Osteo-Ligamentous Finite Element Model of the Lumbar Spine

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.

Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise

The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.

Influence of Cervical Muscle Fatigue on Musculo-Tendinous Stiffness of the Head-Neck Segment during Cervical Flexion

AIM

The aim of this study is to determine if the fatigue of cervical muscles has a significant influence on the head-neck segment musculo-tendinous stiffness.

METHODS

Ten men (aged 21.2 ± 1.9 years) performed four quick-release trials of flexion at 30 and 50% MVC before and after the induction of muscular fatigue on cervical flexors. Electromyographic activity was recorded on the sternocleidomastoids (SCM) and spinal erectors (SE), bilaterally. Musculo-tendinous stiffness was calculated through the quick-release method adapted to the head-neck segment.

RESULTS

We noticed a significant linear increase of the head-neck segment musculo-tendinous stiffness with the increase of exertion level both before (P < 0.0001) and after the fatigue procedure (P < 0.0001). However, this linear relationship was not different before and after the fatigue procedure. EMG analysis revealed a significant increase of the root mean square for the right SCM (P = 0.0002), the left SCM (P < 0.0001), the right SE (P < 0.0001), and the left SE (P < 0.0001) and a significant decrease of the median power frequency only for the right (P = 0.0006) and the left (P = 0.0003) SCM with muscular fatigue.

DISCUSSION

We did not find significant changes in the head-neck segment musculo-tendinous stiffness with fatigue of cervical muscles. We found a significant increase in EMG activity in the SCM and the SE after the induction of fatigue of the SCM. Our findings suggest that with fatigue of cervical flexors, neck muscle activity is modulated in order to maintain the musculo-tendinous stiffness at a steady state.

Age-related differences do affect postural kinematics and joint kinetics during repetitive lifting

BACKGROUND

Age is considered a risk factor for manual handling-related injuries and older workers incur higher injury-related costs than younger co-workers. This study investigated the differences between the kinematics and kinetics of repetitive lifting in two groups of handlers of different ages.

METHODS

Fourteen younger (mean 24.4 yr) and 14 older (mean 47.2 yr) males participated in the study. Participants repetitively lifted a box weighing 13 kg at a frequency of 10 lifts/min for a maximum of 20 min. Postural kinematics (joint and lumbosacral angles and angular velocities) and kinetics (joint moments) were measured throughout the lifting task using motion analysis and ground reaction forces. Muscle fatigue of the erector spinae was assessed using electromyography.

FINDINGS

Peak lumbosacral, trunk, hip and knee flexion angles differed significantly between age groups over the duration of the task, as did lumbosacral and trunk angular velocities. The younger group increased peak lumbar flexion by approximately 18% and approached 99% of maximum lumbosacral flexion after 20 min, whereas the older group increased lumbar flexion by 4% and approached 82% maximum flexion. The younger group had a larger increase in peak lumbosacral and trunk angular velocities during extension, which may be related to the increased back muscle fatigue observed among the younger group.

INTERPRETATION

Older participants appeared to control the detrimental effects of fatigue associated with repetitive lifting and limit lumbar spine range of motion. The higher rates of musculoskeletal injury among older workers may stem from a complex interaction of manual handling risk factors.

Precision markedly attenuates repetitive lift capacity

This study investigated the effect of precision on time to task failure in a repetitive whole-body manual handling task. Twelve participants were required to repetitively lift a box weighing 65% of their single repetition maximum to shoulder height using either precise or unconstrained box placement. Muscle activity, forces exerted at the ground, 2D body kinematics, box acceleration and psychophysical measures of performance were recorded until task failure was reached. With precision, time to task failure for repetitive lifting was reduced by 72%, whereas the duration taken to complete a single lift and anterior deltoid muscle activation increased by 39% and 25%, respectively. Yet, no significant difference was observed in ratings of perceived exertion or heart rate at task failure. In conclusion, our results suggest that when accuracy is a characteristic of a repetitive manual handling task, physical work capacity will decline markedly.

PRACTITIONER SUMMARY

The capacity to lift repetitively to shoulder height was reduced by 72% when increased accuracy was required to place a box upon a shelf. Lifting strategy and muscle activity were also modified, confirming practitioners should take into consideration movement precision when evaluating the demands of repetitive manual handling tasks.

An EMG-driven biomechanical model that accounts for the decrease in moment generation capacity during a dynamic fatigued condition

Although it is well known that fatigue can greatly reduce muscle forces, it is not generally included in biomechanical models. The aim of the present study was to develop an electromyographic-driven (EMG-driven) biomechanical model to estimate the contributions of flexor and extensor muscle groups to the net joint moment during a nonisokinetic functional movement (squat exercise) performed in nonfatigued and in fatigued conditions. A methodology that aims at balancing the decreased muscle moment production capacity following fatigue was developed. During an isometric fatigue session, a linear regression was created linking the decrease in force production capacity of the muscle (normalized force/EMG ratio) to the EMG mean frequency. Using the decrease in mean frequency estimated through wavelet transforms between dynamic squats performed before and after the fatigue session as input to the previous linear regression, a coefficient accounting for the presence of fatigue in the quadriceps group was computed. This coefficient was used to constrain the moment production capacity of the fatigued muscle group within an EMG-driven optimization model dedicated to estimate the contributions of the knee flexor and extensor muscle groups to the net joint moment. During squats, our results showed significant increases in the EMG amplitudes with fatigue (+23.27% in average) while the outputs of the EMG-driven model were similar. The modifications of the EMG amplitudes following fatigue were successfully taken into account while estimating the contributions of the flexor and extensor muscle groups to the net joint moment. These results demonstrated that the new procedure was able to estimate the decrease in moment production capacity of the fatigued muscle group.

Local State Space Temporal Fluctuations: A Methodology to Reveal Changes During a Fatiguing Repetitive Task

The effect of muscular fatigue on temporal and spectral features of muscle activities and motor performance, i.e., kinematics and kinetics, has been studied. It is of value to quantify fatigue related kinematic changes in biomechanics and sport sciences using simple measurements of joint angles. In this work, a new approach was introduced to extract kinematic changes from 2D phase portraits to study the fatigue adaptation patterns of subjects performing elbow repetitive movement. This new methodology was used to test the effect of load and repetition rate on the temporal changes of an elbow phase portrait during a dynamic iso-inertial fatiguing task. The local flow variation concept, which quantifies the trajectory shifts in the state space, was used to track the kinematic changes of an elbow repetitive fatiguing task in four conditions (two loads and two repetition rates). Temporal kinematic changes due to muscular fatigue were measured as regional curves for various regions of the phase portrait and were also expressed as a single curve to describe the total drift behavior of trajectories due to fatigue. Finally, the effect of load and repetition rate on the complexity of kinematic changes, measured by permutation entropy, was tested using analysis of variance with repeated measure design. Statistical analysis showed that kinematic changes fluctuated more (showed more complexity) under higher loads (p=0.014), but did not differ under high and low repetition rates (p=0.583). Using the proposed method, new features for complexity of kinematic changes could be obtained from phase portraits. The local changes of trajectories in epochs of time reflected the temporal kinematic changes in various regions of the phase portrait, which can be used for qualitative and quantitative assessment of fatigue adaptation of subjects and evaluation of the influence of task conditions (e.g., load and repetition rate) on kinematic changes.

Design and evaluation of a novel triaxial isometric trunk muscle strength measurement system

Maximal strength measurements of the trunk have been used to evaluate the maximum functional capacity of muscles and the potential mechanical overload or overuse of the lumbar spine tissues in order to estimate the risk of developing musculoskeletal injuries. A new triaxial isometric trunk strength measurement system was designed and developed in the present study, and its reliability and performance was investigated. The system consisted of three main revolute joints, equipped with torque sensors, which intersect at L5—S1 and adjustment facilities to fit the body anthropometry and to accommodate both symmetric and asymmetric postures in both seated and standing positions. The dynamics of the system was formulated to resolve validly the moment generated by trunk muscles in the three anatomic planes. The optimal gain and offset of the system were obtained using deadweights based on the least-squares linear regression analysis. The R2 results of calibration for all loading courses of all joints were higher than 0.99, which indicated an excellent linear correlation. The results of the validation analysis of the regression model suggested that the mean absolute error and the r.m.s. error were less than 2 per cent of the applied load. The maximum value of the minimum detectable change was found to be 1.63 N m for the sagittal plane torque measurement, 0.8 per cent of the full-scale load. The trial-to-trial variability analysis of the device using deadweights provided intra-class correlation coefficients of higher than 0.99, suggesting excellent reliability. The cross-talk analysis of the device indicated maximum cross-talks of 1.7 per cent and 3.4 per cent when the system was subjected to flexion—extension and lateral bending torques respectively. The trial-to-trial variability of the system during in-vivo strength measurement tests resulted in good to excellent reliability, with intra-class correlation coefficients ranging from 0.69 to 0.91. The results of the maximum voluntary isometric torques exertion measurements for 30 subjects indicated good agreement with the previously published data in the literature. The extensive capabilities and high reliability of the system are promising for more comprehensive investigations on the trunk biomechanics in future, e.g. isometric strength measurement at symmetric and asymmetric postures, muscle endurance, and recruitment pattern analysis.

Fatigue influences the dynamic stability of the torso

Fatigue in the extensor muscles of the torso affects neuromuscular recruitment and control of the spine. The goal of this study was to test whether fatigue influences stability of dynamic torso movements. A controlled laboratory experiment measured the change in the maximum finite-time Lyapunov exponent, lambda(max), before and after fatigue of the extensor muscles. Non-linear analyses were used to compute stability from the embedding dimension and Lyapunov exponent recorded during repetitive dynamic trunk flexion tasks. Torso extensor muscles were fatigued to 60% of their unfatigued isometric maximum voluntary exertion force then stability was re-measured. Independent variables included fatigue, task asymmetry and lower-limb constraint. lambda(max) values increased with fatigue suggesting poorer dynamic stability when fatigued. Embedding dimension declined with fatigue indicating reduced dynamic complexity when fatigued. Fatigue-related changes in spinal stability may contribute to the risk of low-back injury during fatiguing occupational lifting tasks. The findings reported here indicate that one mechanism by which fatigue contributes to low back disorders may be spinal instability. This information may contribute to the development of ergonomic countermeasures to help prevent low back disorders.

The effect of increasing resistance on trunk muscle activity during extension and flexion exercises on training devices

Although progressive resistance training of trunk muscles on devices is very common, today, the effects of increasing resistance on trunk muscle activity during dynamic extension and flexion movements on training devices have not been reported yet. Thirty healthy subjects participated in maximal isometric and submaximal dynamic (at 30%, 50% and 70% of maximum mean torque (MMT)) extension and flexion exercises on Tergumed lumbar training devices. The normalized (as a percentage of maximal voluntary isometric contractions (MVIC)) electromyographic activity of 16 abdominal and back muscles was investigated. The results of the present study indicated that in general, with increasing resistance from 30% MMT to 50% MMT and 70% MMT, the activity of all back muscles during the extension exercises and the activity of all abdominal muscles during the flexion exercises increased significantly. To train strength (>60% of MVIC), low intensities (30% and 50% MMT) appeared sufficient to affect the back muscles, but for the abdominals higher resistance (70% MMT) was required. In contrast to the other back muscles, the lumbar multifidus demonstrated high activity levels during both the extension and the flexion exercises. As the lumbar multifidus is demonstrated to be an important muscle in segmental stabilization of the lumbar spine, this finding may help in understanding the efficacy of rehabilitation programs using specific training devices.

Trunk extensor muscles fatigue affects undisturbed postural control in young healthy adults

BACKGROUND

The purpose of this study was to investigate the effects of trunk extensor muscles fatigue on undisturbed postural control in young healthy adults.

METHODS

Fifteen university students were asked to stand upright as immobile as possible with their eyes closed in two conditions of Fatigue and No fatigue of the trunk extensor muscles. Muscular fatigue was achieved by performing trunk repetitive extensions until maximal exhaustion. Centre of foot pressure displacements, recorded using a force platform, were used to compute the motions of the vertical projection of the centre of gravity and those of the difference between the centre of pressure and those of the difference between the centre of pressure and the vertical projection of the centre of gravity. These motions were processed through space-time and frequency domain analyses.

FINDINGS

Larger centre of pressure minus centre of gravity and centre of gravity motions in the Fatigue than No fatigue condition are observed along both the medio-lateral and antero-posterior axes, this effect being more accentuated along the antero-posterior axis.

INTERPRETATION

The present findings suggest that trunk extensor muscles fatigue deteriorates undisturbed stance control, yielding, along the antero-posterior axis mainly, (1) a greater neuromuscular requirements for ensuring standing control, as indicated by the increased centre of pressure minus centre of gravity motions, and (2) a deterioration of postural performance, as indicated by the increased centre of gravity motions.

Are the maximum shortening velocity and the shape parameter in a Hill-type model of whole muscle related to activation?

Mathematical models of the inter-relationship of muscle force, velocity, and activation are useful in forward dynamic simulations of human movement tasks. The objective of this work was to determine whether the parameters (maximum shortening velocity V(max) and shape parameter k) of a Hill-type muscle model, interrelating muscle force, velocity, and activation, are themselves dependent on the activation. To fulfill this objective, surface EMG signals from four muscles, as well as the kinematics and kinetics of the arm, were recorded from 14 subjects who performed rapid-release elbow extension tasks at 25%, 50%, 75%, and 100% activation (MVC). The experimental elbow flexion angle was tracked by a forward dynamic simulation of the task in which V(max) and k of the triceps brachii were varied at each activation level to minimize the difference between the simulated and experimental elbow flexion angle. Because a preliminary analysis demonstrated no dependency of k on activation, additional simulations were performed with constant k values of 0.15, 0.20, and 0.25. The optimized values of V(max) normalized to the average value within a subject were then regressed onto the activation. Normalized V(max) depended significantly on the activation (p<0.001) for all values of k. Furthermore, the estimated V(max) values were not sensitive to the selected k value. The results support the use of Hill-type models in which V(max) depends on activation in forward dynamic simulations modeling muscles with mixed fiber-type composition recruited in the range of 25-100% activation. The use of more accurate models will lend greater confidence to the results of forward dynamic simulations.

Effect of fatigue on knee kinetics and kinematics in stop-jump tasks

BACKGROUND

Altered motor control strategies in landing and jumping maneuvers are a potential mechanism of noncontact anterior cruciate ligament injury. There are biomechanical differences between male and female athletes in the landing phase of stop-jump tasks. Fatigue is a risk factor in musculoskeletal injuries.

HYPOTHESIS

Lower extremity muscle fatigue alters the knee kinetics and kinematics during the landing phase of 3 stop-jump tasks and increases an athlete's risk of anterior cruciate ligament injury.

STUDY DESIGN

Controlled laboratory study.

METHODS

Three-dimensional videography and force plate data were collected for 20 recreational athletes (10 male and 10 female athletes) performing 3 stop-jump tasks before and after completing a fatigue exercise. Knee joint angles and resultant forces and moments were calculated.

RESULTS

Both male and female subjects had significantly increased peak proximal tibial anterior shear forces (P = .01), increased valgus moments (P = .03), and decreased knee flexion angles (P = .03) during landings of all 3 stop-jump tasks when fatigued. Fatigue did not significantly affect the peak knee extension moment for male or female athletes.

CONCLUSION

Fatigued recreational athletes demonstrate altered motor control strategies, which may increase anterior tibial shear force, strain on the anterior cruciate ligament, and risk of injury for both female and male subjects. CLINIC RELEVANCE: Fatigued athletes may have an increased risk of noncontact anterior cruciate ligament injury.

Lumbar total disc replacement part I: rationale, biomechanics, and implant types

Lumbar total disc replacement is an evolving new technology designed to preserve motion and to perhaps supplant fusion as the current "gold standard" surgical treatment for lumbar degenerative disc disease. Given the intense interest in disc replacement as a paradigm shift from fusion, this article describes the anatomy, physiology, and biomechanics of degenerative disc disease. Various treatment options and their outcomes are reviewed. A brief history of disc replacement surgery is outlined, current indications and commonly accepted contraindications for disc replacement surgery are explained, and current implants likely to be available in the United States are described. An overview of the surgical procedure is provided, with technical tips and pitfalls included. Finally, a standard postoperative regime is described.

Biomechanics of nonfusion implants

Although spine fusion is a versatile and effective technique in the treatment of spinal disorders, increased stresses on adjacent unfused levels lead to symptomatic adjacent level degeneration in many patients. The goal of nonfusion devices in spine surgery is to ablate or unload painful structures while preserving segmental motion. The intended performance of nonfusion devices such as disc replacement, nucleus pulposus replacement, and posterior stabilization devices can be understood from the biomechanics of the functional spinal unit in health and disease and the interplay between the motion segment and the device. Implant design issues can also markedly affect performance.

Muscle activity, internal loads, and stability of the human spine in standing postures: combined model and in vivo studies

STUDY DESIGN

The load in active and passive spinal components as well as the stability margin in standing postures +/- load in hands are studied using both computational model and in vivo studies.

OBJECTIVE

To investigate muscle activity, spinal loads, and system stability in standing postures.

SUMMARY OF BACKGROUND DATA

Study of the human trunk yields a redundant system, the satisfactory solution of which remains yet to be done. Existing biomechanical models are often oversimplified or attempt to solve the problem by equilibrium of loads at only one cross section along the spine.

METHODS

In vivo measurements are performed to obtain kinematics (by skin markers) as input data into model and EMG activity (by surface electrodes) for validation of predictions. A thoracolumbar model, while accounting for nonlinear ligamentous properties and trunk musculature, solved the redundant active-passive system by a novel kinematics-based approach that used both the posture and gravity/external loads as input data. In both studies, neutral standing posture was considered with weights up to 380 N held in hands with arms extended close to the body either in front or on sides.

RESULTS

Predicted muscle forces were in satisfactory agreement with measured EMG activities. The activity in extensor muscles significantly increased with the load magnitude when held in front, a trend that disappeared as loads were held on sides. Abdominal muscles remained relatively silent. Large compression forces of approximately 2000 N were computed in lower lumbar levels when 380 N was held in front. Coactivity in abdominal muscles markedly increased internal loads and stability margin.

CONCLUSION

A tradeoff exists between lower loads in passive tissues (i.e., tissue risk of failure) and higher stability margins as both increase with greater muscle coactivation. Greater muscle activity observed under load held in front did not necessarily yield larger stability margin as the position of load appeared to play an important role as well. The strength of the proposed model is in realistic consideration of both passive-active structures under postures and gravity/external loads, yielding results that satisfy kinematics, equilibrium, and stability requirements in all directions along the spine.

Spectral analysis of the electromyograph of the erector spinae muscle before and after a dynamic manual load-lifting test

The aim of the present study was to assess the spectral behavior of the erector spinae muscle during isometric contractions performed before and after a dynamic manual load-lifting test carried out by the trunk in order to determine the capacity of muscle to perform this task. Nine healthy female students participated in the experiment. Their average age, height, and body mass (+/- SD) were 20 +/- 1 years, 1.6 +/- 0.03 m, and 53 +/- 4 kg, respectively. The development of muscle fatigue was assessed by spectral analysis (median frequency) and root mean square with time. The test consisted of repeated bending movements from the trunk, starting from a 45 masculine angle of flexion, with the application of approximately 15, 25 and 50% of maximum individual load, to the stand up position. The protocol used proved to be more reliable with loads exceeding 50% of the maximum for the identification of muscle fatigue by electromyography as a function of time. Most of the volunteers showed an increase in root mean square versus time on both the right (N = 7) and the left (N = 6) side, indicating a tendency to become fatigued. With respect to the changes in median frequency of the electromyographic signal, the loads used in this study had no significant effect on either the right or the left side of the erector spinae muscle at this frequency, suggesting that a higher amount and percentage of loads would produce more substantial results in the study of isotonic contractions.

Influence of fatigue in neuromuscular control of spinal stability

Lifting-induced fatigue may influence neuromuscular control of spinal stability. Stability is primarily controlled by muscle recruitment, active muscle stiffness, and reflex response. Fatigue has been observed to affect each of these neuromuscular parameters and may therefore affect spinal stability. A biomechanical model of spinal stability was implemented to evaluate the effects of fatigue on spinal stability. The model included a 6-degree-of-freedom representation of the spine controlled by 12 deformable muscles from which muscle recruitment was determined to simultaneously achieve equilibrium and stability. Fatigue-induced reduction in active muscle stiffness necessitated increased antagonistic cocontraction to maintain stability resulting in increased spinal compression with fatigue. Fatigue-induced reduction in force-generating capacity limited the feasible set of muscle recruitment patterns, thereby restricting the estimated stability of the spine. Electromyographic and trunk kinematics from 21 healthy participants were recorded during sudden-load trials in fatigued and unfatigued states. Empirical data supported the model predictions, demonstrating increased antagonistic cocontraction during fatigued exertions. Results suggest that biomechanical factors including spinal load and stability should be considered when performing ergonomic assessments of fatiguing lifting tasks. Potential applications of this research include a biomechanical tool for the design of administrative ergonomic controls in manual materials handling industries.

The current status of lumbar total disc replacement

Total disc replacement is an exciting technology that may one day replace fusion as the gold standard treatment for DDD, but it is currently an experimental procedure in the United States. Promising short- and mid-term results have been reported for TDR, but longer follow-up and randomized trials comparing TDR to fusion and nonsurgical treatment are needed to fully define the role of TDR in the spine surgeon's armamentarium. Short-term complication rates have been acceptably low, but in the long term the durability of TDR implants and the vertebral endplate will provide challenges. Finally, it is essential that practitioners understand that a limited subset of patients are good candidates for TDR and that indiscriminate application of this technology will result in poor outcomes.

Muscle fatigue and fatigue-related biomechanical changes during a cyclic lifting task

STUDY DESIGN

Electromyographic and biomechanical methods were utilized to investigate correlations between indexes of localized muscle fatigue and changes in the kinematics and kinetics of motion during a cyclic lifting task.

SUMMARY OF BACKGROUND DATA

Recent advances in time-frequency analysis procedures for electromyographicic signal processing provide a new way of studying localized muscle fatigue during dynamic contractions. These methods provide a means to investigate fatigue-related functional impairments in patients with low back pain.

OBJECTIVES

To study the relationship between localized muscle fatigue and the biomechanics of lifting and lowering a weighted box. Fatigue-related changes in the electromyographicic signal of trunk and limb muscles were evaluated and compared to kinematic and kinetic measures in order to determine whether lifting strategy is modified with fatigue.

METHODS

A total of 14 healthy male subjects (26 +/- 5 years) cyclically lifted and lowered a 13 kg box (12 lifts/min) for 4.5 minutes. A 5-second static maximum lifting task was included immediately before and after the cyclic lifting task to measure changes in lifting strength and static electromyographicic fatigue indexes. Electromyographic signals from 14 muscle sites (including paravertebral and limb muscles) were measured. Changes in the electromyographicic Instantaneous Median Frequency, a fatigue index, were computed using time-frequency analysis methods. This index was compared with more standardized measures of fatigue, such as those based on electromyographicic median frequency acquired during a static trunk extension test, subjective fatigue measures, and maximal static lifting strength. Biomechanical measures were gathered using a motion analysis system to study kinematic and kinetic changes during the lifting task.

RESULTS

During the cyclic lifting task, the electromyographic Instantaneous Median Frequency significantly decreased over time in the paravertebral muscles, but not in the limb muscles. Paravertebral electromyographicic Instantaneous Median Frequency changes were consistent with self-reports of fatigue as well as decreases in trunk extension strength. The magnitude of muscle-specific changes in electromyographicic Instantaneous Median Frequency was not significantly correlated with electromyographicic median frequency changes from the static trunk extension task. The load of the box relative to the maximal static lifting strength significantly affected the electromyographicic Instantaneous Median Frequency changes of paravertebral back muscles. Significant changes with fatigue during the task were found in the angular displacements at the knee, hip, trunk, and elbow. These biomechanical changes were associated with increased peak torque and forces at the L4-L5 vertebral segment.

CONCLUSIONS

Our results demonstrate correlation between localized muscle fatigue and biomechanical adaptations that occur during a cyclic lifting task. This new technique may provide researchers and clinicians with a means to investigate fatigue-related effects of repetitive work tasks or assessment procedures that might be useful in improving education, lifting ergonomy, and back school programs. Although both the dynamic and static tasks resulted in spectral shifts in the electromyographicic data, the fact that these methods led to different muscle-specific findings indicates that they should not be considered as equivalent assessment procedures.

The implications of constraint in lumbar total disc replacement

Lumbar total disc replacement (TDR) is an evolving technique that has the potential to replace arthrodesis as the gold standard surgical treatment of degenerative disc disease. The interaction between host anatomy and physiology and the biomechanical properties of TDR implants will determine the quality of long-term clinical results. However, there is scant literature addressing this subject. The purpose of this article is to discuss the implications of biomechanical constraint in TDR. Based upon available data for normal motion segments and the design of two TDRs currently in clinical trials, unconstrained designs appear to have a kinematic advantage. They are more likely to provide a physiologic mobile instantaneous axis of rotation (IAR), which may explain why they display greater range of motion in vivo. Their lack of constraint may prevent excessive facet joint or capsuloligamentous loads in the extremes of flexion and extension. Furthermore, since the IAR is mobile, they may be less sensitive to small errors in implant placement. On the other hand, constrained devices appear to have an advantage in protection of the posterior elements from shear loading. Spinal shear loads of considerable magnitude occur during activities of daily living. Whether the transference of stresses to the implant and implant-bone interface is clinically significant is unknown. Although this article focuses on two specific TDR designs, future designs will need to account for the same kinematic and loading concerns regarding constraint. We hope this discussion will assist clinicians and researchers in the design, selection, and clinical comparison of present and future TDR implants.

Lower torso muscle activation patterns for high-magnitude static exertions: gender differences and the effects of twisting

STUDY DESIGN

Surface electromyographic signals were collected from 14 lower torso muscles while participants resisted high-magnitude static trunk moments applied in a variety of directions.

OBJECTIVES

To obtain a description of muscle activations in response to large moment magnitudes and axial twisting, including levels of agonistic and antagonistic muscle cocontraction. To assess differences in lower torso muscle activation patterns associated with gender and trial repetition.

SUMMARY OF BACKGROUND DATA

Back pain is associated with mechanical loads in the back. Biomechanical modeling of these loads is facilitated by knowledge of typical muscle activation patterns. Previous efforts in obtaining such data have often limited their scope to low-magnitude exertions or relatively simple scenarios.

METHODS

Eight male and eight female participants, matched by height and mass, performed static exertions in an apparatus that immobilized their lower body while the activation levels of seven bilateral torso muscles were measured using surface electromyography. Activation patterns were analyzed to assess differences resulting from a variety of factors.

RESULTS

No significant differences in activation patterns were found between genders or repetitions, but moment magnitude and direction elicited substantial differential responses. Good repeatability was found between trial repetitions, as indicated by intraclass correlation coefficients (>0.65). Significant synergistic muscle coactivation, large intersubject variability (mean coefficient of variation 82.2%), and consistent levels of antagonism ranging from 10% to 30% maximum voluntary exertions were observed.

CONCLUSIONS

Individuals of different genders, but similar anthropometry, have comparable muscular reactions to complex torso loads, suggesting similar motor control strategies. Future spine models should consider that the variability in muscle recruitment patterns is larger between subjects than within subjects. High-magnitude exertions, especially those with moment loads in more than one plane, require most muscles to be active (>5%) and moderate levels of antagonism.

Generalizability of trunk muscle EMG and spinal forces

The generalizability of trunk muscle EMG and spinal loading estimates obtained from an EMG-assisted biomechanical model was assessed over three occasions and three repetitions. The greatest sources of variability consisted of the intersubject differences and the interaction between subject and occasion. The ID (reliability coefficient) was less for trunk muscle activity compared with estimates of anteroposterior shear force, compression force, and gain computed from the biomechanical model. In order to obtain an ID of 0.8, we recommend five testing occasions for submaximal EMG measurements and three testing occasions for biomechanical estimates. Reproducible estimates of maximal trunk extensor EMG could not be obtained within five testing occasions and five repetitions. Although many recruitment patterns could cause the same extension torque output, their net effect on internal loading seems to be less variable than the underlying measurements.

Trunk muscle coactivation in preparation for sudden load

Biomechanical stability of the lumbar spine is an important factor in the etiology and control of low-back disorders. A principle component of biomechanical stability is the musculoskeletal stiffening generated by preparatory muscle coactivation. The goal of this investigation was to quantify preparatory behavior, evaluating trunk muscle activity immediately prior to sudden trunk flexion loading during static extension tasks compared to activity observed when subjects were informed no sudden load would occur. Coactive excitation was also examined as a function of fatigue and gender. Results demonstrated increased extensor muscle and flexor muscle coactivation following static fatiguing exertions, potentially compensating for reduced trunk stiffness. Female subjects produced greater flexor antagonism than in the males. No difference in the preparatory coactive muscle recruitment patterns were observed when subjects were expecting a sudden flexion load compared to recruitment patterns observed in similar static postures when subjects were informed no sudden load would be applied. This indicates the neuromuscular system relies greatly on response characteristics for the maintenance of stability in dynamic loading conditions.