The effect of angle and level of exertion on trunk neuromuscular performance during multidirectional isometric activities

Test-retest reliability and construct validity of trunk extensor muscle force modulation accuracy

Low back pain is associated with changes in trunk muscle structure and function and motor control impairments. Voluntary force modulation (FM) of trunk muscles is a unique and under-investigated motor control characteristic. One of the reasons for this paucity of evidence is the lack of exploration and publication on the reliability and validity of trunk FM protocols. The purpose of this study was to determine the within- and between-day test-retest reliability and construct validity for trunk extensor muscle FM. Twenty-nine healthy participants were tested under three FM conditions with different modulation rates. Testing was performed on a custom-built apparatus designed for trunk isometric force testing. FM accuracy relative to a fluctuating target force (20-50%MVF) was quantified using the root mean square error of the participant's generated force relative to the target force. Reliability and precision of measurement were assessed using the Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM), minimal detectable difference (MDD95), and Bland-Altman plots. In a subset of participants, we collected surface electromyography of trunk and hip muscles. We used non-negative matrix factorization (NNMF) to identify the underlying motor control strategies. Within- and between-day test-retest reliability was excellent for FM accuracy across the three conditions (ICC range: 0.865 to 0.979). SEM values ranged 0.9-1.8 Newtons(N) and MDD95 ranged from 2.4-4.9N. Conditions with faster rates of FM had higher ICCs. NNMF analysis revealed two muscle synergies that were consistent across participants and conditions. These synergies demonstrate that the muscles primarily involved in this FM task were indeed the trunk extensor muscles. This protocol can consistently measure FM accuracy within and between testing sessions. Trunk extensor FM, as measured by this protocol, is not specific to any trunk muscle group but is the result of modulation by all the trunk extensor muscles.

Effects of Resistance Training as a Behavioural Preventive Measure on Musculoskeletal Complaints, Maximum Strength and Ergonomic Risk in Dentists and Dental Assistants

INTRODUCTION

For dental professionals, musculoskeletal disorders (MSD) are common health hazards and resistance training programmes have been promising approaches in the quest for a reduction in the pain intensity of these professionals. Therefore, the aim of the current study was to investigate the effect of a trunk-oriented 10-week resistance training programme.

METHOD

In total, the study was conducted with 17 dentists and dental assistants (3 m/14 f) over a course of 10 weeks, with workouts being performed 2 times a week using a 60 min intervention programme consisting of 11 resistance training exercises. The outcome values that were collected were the pain intensity (visual analogue scale (VAS) combined with a modified version of the Nordic Questionnaire), the MVIC and the rapid upper limb assessment (RULA) score (based on data from inertial motion units) during a standardised dental treatment protocol.

RESULTS

A significant reduction in pain intensity was found for each queried body region: the neck, upper back, lower back and the right and left shoulders. The maximum voluntary isometric contraction (MVIC) improved significantly in all outcome measures: flexion, extension, right and left lateral flexion and right and left rotation.

CONCLUSIONS

A 10-week resistance training programme for dentists and dental assistants had significant effects on pain intensity reduction and the MVIC of the musculature of the trunk and is, therefore, suitable as a behavioural preventive measure against MSD in dental professionals.

Trunk control during repetitive sagittal movements following a real-time tracking task in people with chronic low back pain

Precision of trunk movement has commonly been examined by testing relocation accuracy rather than evaluating accuracy of tracking dynamic movement. In this study we used a 3-D motion capture system to provide a novel real-time tracking task to assess trunk motor control at varying movement speeds between people with and without chronic non-specific low back pain (LBP). Eleven asymptomatic volunteers and 15 participants with chronic non-specific LBP performed 12 continuous cycles of trunk flexion-extension following real time visual feedback, during which, trunk motion was measured using eight optoelectronic infrared cameras. Significant time differences between the feedback and actual trunk motion were found between groups (P = 0.001). Both groups had similar variability of tracking accuracy when following the feedback (P > 0.05). However, tracking variability at a slow speed correlated (P = 0.03; r = 0.55) with the Fear-Avoidance Beliefs Questionnaire (FABQ) scores in those with LBP. This study shows that both asymptomatic people and individuals with LBP displayed anticipatory behaviour, however, the response of those with LBP was consistently delayed in tracking the visual feedback compared to the asymptomatic group. Additionally, the extent of variability of tracking accuracy over repeated tracking cycles was associated with the degree of fear of movement in people with LBP.

Simulation of movement in three-dimensional musculoskeletal human lumbar spine using directional encoding-based neurocontrollers

Despite development of accurate musculoskeletal models for human lumbar spine, the methods for prediction of muscle activity patterns in movements lack proper association with corresponding sensorimotor integrations. This paper uses the directional information of the Jacobian of the musculoskeletal system to orchestrate adaptive critic-based fuzzy neural controller modules for controlling a complex nonlinear redundant musculoskeletal system. The proposed controller is used to control a 3D 3-degree of freedom (DOF) musculoskeletal model of trunk, actuated by 18 muscles. The controller is capable of learning to control from sensory information, without relying on pre-assumed model parameters. Simulation results show satisfactory tracking of movements and the simulated muscle activation patterns conform to previous EMG experiments and optimization studies. The proposed controller can be used as a computationally inexpensive muscle activity generator to distinguish between neural and mechanical contributions to movement and for study of sensory versus motor origins of motor function and dysfunction in human spine.

The effect of chronic low back pain on trunk accuracy in a multidirectional isometric tracking task

STUDY DESIGN

A cross-sectional study to quantify trunk motor control during multidirectional isometric tracking tasks.

OBJECTIVE

To investigate the effect of chronic low back pain (LBP) on trunk neuromuscular performance while participants performed isometric exertions of trunk muscles to track targets in different angles with various magnitudes.

SUMMARY OF BACKGROUND DATA

Tracking tasks especially in multidirectional activities are among the common research methods to quantify human motor control in different conditions. However, little information is available on trunk motor control during these tasks. There is no study investigating trunk accuracy during multidirectional isometric tracking tasks in patients with LBP.

MATERIALS AND METHODS

Twelve patients with chronic LBP and 16 asymptomatic participants performed isometric target tracking tasks in 12 different directions with varying magnitude, from 0% to 80% of individual maximum voluntary exertion, in upright standing posture. The tracking system included a moving target object that moved on a straight line in a predefined angle with the rate of 6% maximum voluntary exertion/s. Trunk accuracy was quantified by computing constant error and variable error during each trial. A mixed model repeated measure analysis of variance was conducted to assess statistical analysis.

RESULTS

Patients with chronic LBP track the target object with higher error compared with healthy controls across almost all of the target angles (P < 0.01). Trunk accuracy decreased significantly in higher level of exertions (P < 0.01).

CONCLUSION

The results provided additional evidence of a change in trunk control strategies in patients with chronic LBP. Decreased accuracy of trunk during isometric tracking tasks especially in higher levels of asymmetric exertions may explain higher risk of low back injuries in these activities.

LEVEL OF EVIDENCE

4.

Development of a device for measurement of multi-directional isometric trunk kinetics in a seated position

Trunk torque is typically quantified in a single plane. This is not ideal since any unmeasured coupled trunk kinetics in other directions, than the intended one, could affect the accuracy and reliability of the strength measurements as well as the ability to corroborate findings with electromyographic recordings. Therefore, an isometric device that simultaneously records trunk kinetics across planes has been developed to aid in the research of trunk control in both the healthy or impaired populations. This device utilizes a six degree-of-freedom load cell and custom designed frame to attach individuals while in the sitting position. The performance of the device was tested in six healthy controls and while using two protocols. The device was able to detect coupled trunk kinetics during maximum lateral flexion and axial twisting torque generation. It also allowed the implementation of a multi-axis isometric protocol showing that subjects were able to generate larger amounts of axial torque during sub-maximal trunk extension compared to sub-maximal trunk flexion. In conclusion, the device and mechanical transformations discussed in this article will aid in the interpretation of multi-directional isometric trunk kinetics in a wide range of populations.

The effect of exertion level on activation patterns and variability of trunk muscles during multidirectional isometric activities in upright posture

STUDY DESIGN

An experimental design to investigate activation patterns of trunk muscles during multidirectional exertions.

OBJECTIVES

To evaluate trunk muscle activation patterns in varying directions and moment magnitudes during an isometric task, and to investigate the effects of angle and level of isometric exertion on the electromyography (EMG) variability of trunk muscles in upright posture.

SUMMARY OF BACKGROUND DATA

Few studies have investigated trunk muscle activation patterns in multidirectional exertions with different moment magnitudes.

METHODS

A total of 12 asymptomatic male subjects were participated in the study. The EMG activity of 10 selected trunk muscles was collected in the 3 seconds end point matching tasks in 8 angles and 3 magnitudes of exertion. Trunk muscle activation patterns were examined using EMG tuning curves and measuring preferred direction (mean vector direction) and the index of spatial focus. The effect of exertion level on these measures was investigated by Rao test. The effects of angle and level of exertion on the EMG variability of trunk muscles were tested by analysis of variance with repeated measures design.

RESULTS

No significant difference in EMG tuning curves, preferred direction, and the index of spatial focus was found for each muscle studied across exertion levels (P > 0.05). The index of spatial focus of most muscles studied was not changed with increasing moment magnitude. EMG variability of trunk muscles was significantly affected by angle and level of exertion and their interaction effect (P < 0.001).

CONCLUSION

Consistent activation patterns of trunk muscles were found within and among subjects in different moment magnitudes. The index of spatial focus indicated that probably no shift to a higher co-contraction strategy has been adapted with increasing moment magnitude. The results suggested that increased EMG variability of trunk muscles in asymmetric exertions may be associated with lower trunk controllability during combined exertions.

How does the central nervous system address the kinetic redundancy in the lumbar spine? Three-dimensional isometric exertions with 18 Hill-model-based muscle fascicles at the L4—L5 level

The human motor system is organized for execution of various motor tasks in a different and flexible manner. The kinetic redundancy in the human musculoskeletal system is a significant property by which the central nervous system achieves many complementary goals. An equilibrium-based biomechanical model of isometric three-dimensional exertions of trunk muscles has been developed. Following the definition and role of the uncontrolled manifold, the kinetic redundancy concept is explored in mathematical terms. The null space of the kinetically redundant system when a certain joint moment and/or stiffness are needed is derived and discussed. The aforementioned concepts have been illustrated, using a three-dimensional three-degrees-of-freedom biomechanical model of the spine with 18 anatomically oriented Hill-type-model muscle fascicles. The considerations of stability and its consequence on the internal loading of the spine and coactivation consequences are discussed in both general and specific cases. The results can shed light on the interaction mechanisms in muscle activation patterns seen in various tasks and exertions and can provide a significant understanding for future research studies and clinical practices related to low-back disorders. Alteration of recruitment patterns in low-back-pain patients has been explained on the basis of this biomechanical analysis. The higher coactivation results in higher internal loading while providing higher joint stiffness that enhances spinal stability, which guards against spinal deformation in the presence of any perturbations.

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.