Trunk strength,muscle activity and spinal loads in maximum isometric flexion and extension exertions: A combined in vivo-computational study

Determination of the trunk maximum voluntary exertion moment capacity and associated internal spinal forces could serve in proper selection of workers for specific occupational task requirements, injury prevention and treatment outcome evaluations. Maximum isometric trunk exertion moments in flexion and extension along with surface EMG of select trunk muscles are measured in 12 asymptomatic subjects. Subsequently and under individualized measured harness-subject forces, kinematics and upper trunk gravity, an iterative kinematics-driven finite element model is used to compute muscle forces and spinal loads in 4 of these subjects. Different co-activity and intra-abdominal pressure levels are simulated. Results indicate significantly larger maximal resistant moments and spinal compression/shear forces in extension exertions than flexion exertions. The agonist trunk muscles reach their maximum force generation (saturation) to greater extent in extension exertions compared to flexion exertions. Local lumbar extensor muscles are highly active in extension exertions and generate most of the internal spinal forces. The maximum exertion attempts produce large spinal compression and shear loads that increase with the antagonist co-activity level but decrease with the intra-abdominal pressure. Intra-abdominal pressure decreases agonist muscle forces in extension exertions but generally increase them in flexion exertions.     

Simulation of the effects of different pilot helmets on neck loading during air combat

New generation pilot helmets with mounted devices enhance the capabilities of pilots substantially. However, the additional equipment increases the helmet weight and shifts its center of mass forward. Two helmets with different mass properties were modeled to simulate their effects on the pilot's neck. A musculoskeletal computer model was used, with the methods of inverse dynamics and static optimization, to compute the muscle activations and joint reaction forces for a given range of quasi-static postures at various accelerations experienced during air combat. Head postures which induce much higher loads on the cervical spine than encountered in a neutral position could be identified. The increased weight and the forward shift of the center of mass of a new generation helmet lead to higher muscle activations and higher joint reaction loads over a wide range of head and neck movements. The muscle activations required to balance the head and neck in extreme postures increased the compressive force at the T1-C7 level substantially, while in a neutral posture the muscle activations remained low. The lateral neck muscles can reach activations of 100% and cause compressive joint forces up to 1100N during extensive rotations and extensions at high 'vertical' accelerations (Gz). The calculated values have to be interpreted with care as the model has not been validated. Nevertheless, this systematic analysis could separate the effects of head posture, acceleration and helmet mass on neck loading. More reliable data about mass properties and muscle morphometry with a more detailed motion analysis would help to refine the existing model.     

Model and in vivo studies on human trunk load partitioning and stability in isometric forward flexions

To resolve the trunk redundancy to determine muscle forces, spinal loads, and stability margin in isometric forward flexion tasks, combined in vivo-numerical model studies was undertaken. It was hypothesized that the passive resistance of both the ligamentous spine and the trunk musculature plays a crucial role in equilibrium and stability of the system. Fifteen healthy males performed free isometric trunk flexions of approximately 40 degrees and approximately 65 degrees +/- loads in hands while kinematics by skin markers and EMG activity of trunk muscles by surface electrodes were measured. A novel kinematics-based approach along with a nonlinear finite element model were iteratively used to calculate muscle forces and internal loads under prescribed measured postures and loads considered in vivo. Stability margin was investigated using nonlinear, linear buckling, and perturbation analyses under various postures, loads and alterations in ligamentous stiffness. Flexion postures significantly increased activity in extensor muscles when compared with standing postures while no significant change was detected in between flexed postures. Compression at the L5-S1 substantially increased from 570 and 771 N in upright posture, respectively, for +/-180 N, to 1912 and 3308 N at approximately 40 degrees flexion, and furthermore to 2332 and 3850 N at approximately 65 degrees flexion. Passive ligamentous/muscle components resisted up to 77% of the net moment. In flexion postures, the spinal stability substantially improved due both to greater passive stiffness and extensor muscle activities so that, under 180 N, no muscle stiffness was required to maintain stability. The co-activity of abdominal muscles and the muscle stiffness were of lesser concern to maintain stability in forward flexion tasks as compared with upright tasks. An injury to the passive system, on one hand, required a substantial compensatory increase in active muscle forces which further increased passive loads and, hence, the risk of injury and fatigue. On the other hand, it deteriorated the system stability which in turn could require greater additional muscle activation. This chain of events would place the entire trunk active-passive system at higher risks of injury, fatigue and instability.     

Trunk Muscle Activation at the Initiation and Braking of Bilateral Shoulder Flexion Movements of Different Amplitudes

The aim of this study was to investigate if trunk muscle activation patterns during rapid bilateral shoulder flexions are affected by movement amplitude. Eleven healthy males performed shoulder flexion movements starting from a position with arms along sides (0°) to either 45°, 90° or 180°. EMG was measured bilaterally from transversus abdominis (TrA), obliquus internus (OI) with intra-muscular electrodes, and from rectus abdominis (RA), erector spinae (ES) and deltoideus with surface electrodes. 3D kinematics was recorded and inverse dynamics was used to calculate the reactive linear forces and torque about the shoulders and the linear and angular impulses. The sequencing of trunk muscle onsets at the initiation of arm movements was the same across movement amplitudes with ES as the first muscle activated, followed by TrA, RA and OI. All arm movements induced a flexion angular impulse about the shoulders during acceleration that was reversed during deceleration. Increased movement amplitude led to shortened onset latencies of the abdominal muscles and increased level of activation in TrA and ES. The activation magnitude of TrA was similar in acceleration and deceleration where the other muscles were specific to acceleration or deceleration. The findings show that arm movements need to be standardized when used as a method to evaluate trunk muscle activation patterns and that inclusion of the deceleration of the arms in the analysis allow the study of the relationship between trunk muscle activation and direction of perturbing torque during one and the same arm movement.     

Muscle specificity in tests of cervical flexor muscle performance.

The deep cervical flexor (DCF) muscles are considered to be of substantial clinical importance in the management of neck pain. While conventional cervical flexion (CF) dynamometry methods have been used frequently to assess the capacity of the cervical flexor muscles, it has been suggested that cranio-cervical flexion (CCF) methods may provide a more specific test of DCF muscle performance. This study compared the activation of the deep and superficial cervical flexor muscles between tests of isometric cranio-cervical flexion (CCF) and conventional cervical flexion (CF) dynamometry. Normalised root-mean-square values were recorded for the deep cervical flexor (DCF), sternocleidomastoid (SCM), anterior scalene (AS), and sternohyoid (SH) muscles during isometric CCF and CF tests at maximal voluntary contraction (MVC), 50% MVC, and 20% MVC in ten healthy volunteers. The results demonstrated significantly greater electromyography (EMG) amplitude for the SCM (P<.001-.002) and AS (P<.001-.001) muscles in the CF test conditions (MVC, 20%MVC, and 50%MVC) compared to CCF test conditions. Moreover, the SH muscle demonstrated significantly greater EMG amplitude during CF compared to CCF but only in the 50% MVC and 20% MVC conditions (P=.007 and .02 respectively). These results demonstrate that dynamometry tests of CF result in greater activity of the superficial cervical flexor muscles compared to tests of CCF. As a result, CCF dynamometry may provide a more specific method to assess and retrain DCF muscle performance, compared to conventional CF in which superficial muscle activity may mask impaired performance of the DCF muscles.     

The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine

Occupations that involve sustained or repetitive neck flexion are associated with a higher incidence of neck pain. Little in vivo information is available on the impact of static neck flexion on cervical spinal tissue. The aim of this study was to assess changes in mechanical and neuromuscular behaviors to sustained neck flexion in healthy adults. Sixty healthy subjects aged 20–35 years participated in this study. The participants were exposed to static neck flexion at a fixed angle of full flexion for 10 min. Mechanical and neuromuscular responses of the cervical spine to sudden perturbations were measured pre- and post-exposure. Magnitude of load-relaxation during flexion exposure, stiffness, peak head angular velocity, and reflexive activities of cervical muscles were recorded. Effective neck stiffness decreased significantly, especially in female participants (P = 0.0001). The reflexive response of the cervical erector spinae muscles to head perturbation delayed significantly (P = 0.0001). Peak head angular velocity was significantly increased after exposure to neck flexion for 10 min, especially in female participants (P = 0.001). In the present study, static flexion resulted in changes in mechanical and neuromuscular behavior of the cervical spine, potentially leading to decreased stiffness of the cervical spine. The results confirm the importance of maintaining a correct head and neck position during work and improving the work environment to reduce the cervical spinal load and work-related neck pain.     

The Effects of Backward Adjustable Thoracic Support in Wheelchair on Spinal Curvature and Back Muscle Activation for Elderly People

Objectives

To investigate the effects of backward adjustable thoracic support on spinal curvature and back muscle activation during wheelchair sitting.

Methods

Twenty elderly people were recruited for this study. The backward adjustable thoracic support sitting posture was compared with the slumped, normal, and lumbar support sitting postures. Spinal curvatures (pelvic, lumbar, and thoracic angles) and muscle activations of 4 back muscles on both sides (maximal voluntary isometric contraction of the lumbar multifidus, lumbar erector spinae, iliocostalis lumborum pars thoracis, and thoracic erector spinae at T9) were measured and compared between the different sitting postures using one-way analysis of variance with repeated measures.

Results

The backward adjustable thoracic support sitting posture showed a relatively neutral pelvic tilt (−0.32±4.80°) when compared with the slumped (22.84±5.27°) and lumbar support (−8.97±3.31°) sitting postures (P<0.001), and showed relatively higher lumbar lordosis (−23.38±6.50°) when compared with the slumped (14.77±7.83°), normal (0.44±7.47°), and lumbar support (−16.76±4.77°) sitting postures (P<0.05). It also showed relatively lower back muscle activity when compared with the normal and lumbar support sitting postures (P<0.05).

Conclusions

The backward adjustable thoracic support sitting concept was suggested because it maintains a more neutral pelvic tilt, higher lumbar lordosis, and lower back muscle activation, which may help maintain a better sitting posture and reduce the risk of back pain.     

Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles

A novel surface electromyographic (EMG) technique was recently described for the detection of deep cervical flexor muscle activity. Further investigation of this technique is warranted to ensure EMG activity from neighbouring muscles is not markedly influencing the signals recorded. This study compared deep cervical flexor (DCF) muscle activity with the activity of surrounding neck and jaw muscles during various anatomical movements of the neck and jaw in 10 volunteer subjects. DCF EMG activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid, anterior scalene, masseter and suprahyoid muscles. Positioned in supine, subjects performed isometric cranio-cervical flexion, cervical flexion, right and left cervical rotation, jaw clench and resisted jaw opening. Across all movements examined, EMG amplitude of the DCF muscles was greatest during neck movements that would require activity of the DCF muscles, particularly during cranio-cervical flexion, their primary anatomical action. The actions of jaw clench and resisted jaw opening demonstrated significantly less DCF EMG activity than the cranio-cervical flexion action (p < 0.05). Across all other movements, the neighbouring neck and jaw muscles demonstrated greatest EMG amplitude during their respective primary anatomical actions, which occurred in the absence of increased EMG amplitude recorded from the DCF muscles. The finding of substantial EMG activity of the DCF muscles only during neck actions that would require their activity, particularly cranio-cervical flexion, and not during actions involving the jaw, provide further assurance that the majority of myoelectric signals detected from the nasopharyngeal electrode are from the DCF muscles.     

The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises.

The purpose of this study was to investigate the recruitment pattern of deep and superficial neck flexors evoked by three different cervical flexion exercises using muscle functional MRI. In 19 healthy participants, transverse relaxation time (T2) values were calculated for the longus colli (Lco), longus capitis (Lca), and sternocleidomastoid (SCM) at rest and following three exercises: conventional cervical flexion (CF), craniocervical flexion (CCF), and a combined craniocervical flexion and cervical flexion (CCF-CF). CCF-CF gave the highest T2 increase for all muscles. CCF displayed a significantly higher T2 increase for the Lca compared with the Lco and the SCM. When comparing the CCF and CF, no significant difference was found for the Lca, whereas the Lco and SCM displayed a higher T2 increase during CF compared with CCF. This study shows that muscle functional MRI can be used to characterize the specific activation levels and recruitment patterns of the superficial and deep neck flexors during different cervical flexion exercises. During CCF-CF, all synergists are maximally recruited, which makes this exercise useful for high-load training. CCF may provide a more specific method to assess and retrain Lca muscle performance compared with CF and CCF-CF. This study highlights the need to differentiate between the Lco and Lca when evaluating their function, since these results demonstrate a clear difference in activation of both muscles.     

The neutral posture of the cervical spine is not unique in human subjects

Cervical spine injuries often happen in dynamic environments (e.g., sports and motor vehicle crashes) where individuals may be moving their head and neck immediately prior to impact. This motion may reposition the cervical vertebrae in a way that is dissimilar to the upright resting posture that is often used as the initial position in cadaveric studies of catastrophic neck injury. Therefore our aim was to compare the “neutral” cervical alignment measured using fluoroscopy of 11 human subjects while resting in a neutral posture and as their neck passed through neutral during the four combinations of active flexion and extension movements in both an upright and inverted posture. Muscle activation patterns were also measured unilaterally using surface and indwelling electromyography in 8 muscles and then compared between the different conditions. Overall, the head posture, cervical spine alignment and muscle activation levels were significantly different while moving compared to resting upright. Compared to the resting upright condition, average head postures were 6–13° more extended, average vertebral angles varied from 11° more extended to 10° more flexed, and average muscle activation levels varied from unchanged to 10% MVC more active, although the exact differences varied with both direction of motion and orientation. These findings are important for ex vivo testing where the head and neck are statically positioned prior to impact – often in an upright neutral posture with negligible muscle forces – and suggest that current cadaveric head-first impact tests may not reflect many dynamic injury environments.     

Electromyography of superficial and deep neck muscles during isometric, voluntary, and reflex contractions

Increasingly complex models of the neck neuromusculature need detailed muscle and kinematic data for proper validation. The goal of this study was to measure the electromyographic activity of superficial and deep neck muscles during tasks involving isometric, voluntary, and reflexively evoked contractions of the neck muscles. Three male subjects (28-41 years) had electromyographic (EMG) fine wires inserted into the left sternocleidomastoid, levator scapulae, trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles. Surface electrodes were placed over the left sternohyoid muscle. Subjects then performed: (i) maximal voluntary contractions (MVCs) in the eight directions (45 deg intervals) from the neutral posture; (ii) 50 N isometric contractions with a slow sweep of the force direction through 720 deg; (iii) voluntary oscillatory head movements in flexion and extension; and (iv) initially relaxed reflex muscle activations to a forward acceleration while seated on a sled. Isometric contractions were performed against an overhead load cell and movement dynamics were measured using six-axis accelerometry on the head and torso. In all three subjects, the two anterior neck muscles had similar preferred activation directions and acted synergistically in both dynamic tasks. With the exception of splenius capitis, the posterior and posterolateral neck muscles also showed consistent activation directions and acted synergistically during the voluntary motions, but not during the sled perturbations. These findings suggest that the common numerical-modeling assumption that all anterior muscles act synergistically as flexors is reasonable, but that the related assumption that all posterior muscles act synergistically as extensors is not. Despite the small number of subjects, the data presented here can be used to inform and validate a neck model at three levels of increasing neuromuscular-kinematic complexity: muscles generating forces with no movement, muscles generating forces and causing movement, and muscles generating forces in response to induced movement. These increasingly complex data sets will allow researchers to incrementally tune their neck models' muscle geometry, physiology, and feedforward/feedback neuromechanics.     

Spinal Motion and Muscle Activity during Active Trunk Movements – Comparing Sheep and Humans Adopting Upright and Quadrupedal Postures

Sheep are used as models for the human spine, yet comparative in vivo data necessary for validation is limited. The purpose of this study was therefore to compare spinal motion and trunk muscle activity during active trunk movements in sheep and humans. Three-dimensional kinematic data as well as surface electromyography (sEMG) of spinal flexion and extension was compared in twenty-four humans in upright (UR) and 4-point kneeling (KN) postures and in 17 Austrian mountain sheep. Kinematic markers were attached over the sacrum, posterior iliac spines, and spinous and transverse processes of T5, T8, T11, L2 and L5 in humans and over the sacrum, tuber sacrale, T5, T8, T12, L3 and L7 in sheep. The activity of erector spinae (ES), rectus abdominis (RA), obliquus externus (OE), and obliquus internus (OI) were collected. Maximum sEMG (MOE) was identified for each muscle and trial, and reported as a percentage (MOE%) of the overall maximally observed sEMG from all trials. Spinal range of motion was significantly smaller in sheep compared to humans (UR / KN) during flexion (sheep: 6–11°; humans 12–34°) and extension (sheep: 4°; humans: 11–17°). During extension, MOE% of ES was greater in sheep (median: 77.37%) than UR humans (24.89%), and MOE% of OE and OI was greater in sheep (OE 76.20%; OI 67.31%) than KN humans (OE 21.45%; OI 19.34%), while MOE% of RA was lower in sheep (21.71%) than UR humans (82.69%). During flexion, MOE% of RA was greater in sheep (83.09%) than humans (KN 47.42%; UR 41.38%), and MOE% of ES in sheep (45.73%) was greater than KN humans (14.45%), but smaller than UR humans (72.36%). The differences in human and sheep spinal motion and muscle activity suggest that caution is warranted when ovine data are used to infer human spine biomechanics.     

Activation of Neck and Low-Back Muscles Is Reduced with the Use of a Neck Balance System Together with a Lumbar Support in Urban Drivers

Driving is associated with high activation of low-back and neck muscles due to the sitting position and perturbations imposed by the vehicle. The aim of this study was to investigate the use of a neck balance system together with a lumbar support on the activation of low-back and neck muscles during driving. Twelve healthy male subjects (age 32±6.71 years) were asked to drive in two conditions: 1) with devices; 2) without devices. During vehicle accelerations and decelerations root mean square (RMS) of surface electromyography (sEMG) was recorded from the erector spinae, semispinalis capitis and sternocleidomastoid muscles and expressed as a percentage of maximal voluntary contraction (MVC). The pitch of the head was obtained by means of an inertial sensor placed on the subjects’ head. A visual analog scale (VAS) was used to assess the level of perceived comfort. RMS of the low back muscles was lower with than without devices during both acceleration and deceleration of the vehicle (1.40±0.93% vs 29 2.32±1.90% and 1.88±1.45% vs 2.91±2.33%, respectively), while RMS of neck extensor muscles was reduced only during acceleration (5.18±1.96% vs 5.91±2.16%). There were no differences between the two conditions in RMS of neck flexor muscles, the pitch of the head and the VAS score. The use of these two ergonomic devices is therefore effective in reducing the activation of low-back and neck muscles during driving with no changes in the level of perceived comfort, which is likely due to rebalancing weight on the neck and giving a neutral position to lumbar segments.     

Neuromuscular Activation of the Vastus Intermedius Muscle during Isometric Hip Flexion

Although activity of the rectus femoris (RF) differs from that of the other synergists in quadriceps femoris muscle group during physical activities in humans, it has been suggested that the activation pattern of the vastus intermedius (VI) is similar to that of the RF. The purpose of present study was to examine activation of the VI during isometric hip flexion. Ten healthy men performed isometric hip flexion contractions at 25%, 50%, 75%, and 100% of maximal voluntary contraction at hip joint angles of 90°, 110° and 130°. Surface electromyography (EMG) was used to record activity of the four quadriceps femoris muscles and EMG signals were root mean square processed and normalized to EMG amplitude during an isometric knee extension with maximal voluntary contraction. The normalized EMG was significantly higher for the VI than for the vastus medialis during hip flexion at 100% of maximal voluntary contraction at hip joint angles of 110° and 130° (P < 0.05). The onset of VI activation was 230–240 ms later than the onset of RF activation during hip flexion at each hip joint angle, which was significantly later than during knee extension at 100% of maximal voluntary contraction (P < 0.05). These results suggest that the VI is activated later than the RF during hip flexion. Activity of the VI during hip flexion might contribute to stabilize the knee joint as an antagonist and might help to smooth knee joint motion, such as in the transition from hip flexion to knee extension during walking, running and pedaling.     

Analysis of muscle activation patterns during transitions into and out of high knee flexion postures

Increased risk of medial tibiofemoral osteoarthritis (OA) is linked to occupations that require frequent transitions into and out of postures which require high knee flexion (>90°). Muscle forces are major contributors to joint loading, and an association between compressive forces due to muscle activations and the degeneration of joint cartilage has been suggested. The purpose of this study was to evaluate muscle activation patterns of muscles crossing the knee during transitions into and out of full-flexion kneeling and squatting, sitting in a low chair, and gait. Both net and co-activation were greater when transitioning out of high flexion postures, with maximum activation occurring at knee angles greater than 100°. Compared to gait, co-activation levels during high flexion transitions were up to approximately 3 times greater. Co-activation was significantly greater in the lateral muscle group compared to the medial group during transitions into and out of high flexion postures. These results suggest that compression due to activation of the medial musculature of the knee may not be the link between high knee flexion postures and increased medial knee OA observed in occupational settings. Further research on a larger subject group and workers with varying degrees of knee OA is necessary.     

Electrically induced muscle cramps induce hypertrophy of calf muscles in healthy adults

Objectives:

Skeletal muscles usually cramp at short lengths, where the tension that can be exerted by muscle fibers is low. Since high tension is an important anabolic stimulus, it is questionable if cramps can induce hypertrophy and strength gains. In the present study we investigated if electrically induced cramps (EIMCs) can elicit these adaptations.

Methods:

15 healthy male adults were randomly assigned to an intervention (IG; n=10) and a control group (CG; n=5). The cramp protocol (CP) applied twice a week to one leg of the IG, consisted of 3x6 EIMCs, of 5 s each. Calf muscles of the opposite leg were stimulated equally, but were hindered from cramping by fixating the ankle at 0° plantar flexion (nCP).

Results:

After six weeks, the cross sectional area of the triceps surae was similarly increased in both the CP (+9.0±3.4%) and the nCP (+6.8±3.7%). By contrast, force of maximal voluntary contractions, measured at 0° and 30° plantar flexion, increased significantly only in nCP (0°: +8.5±8.8%; 30°: 11.7±13.7%).

Conclusion:

The present data indicate that muscle cramps can induce hypertrophy in calf muscles, though lacking high tension as an important anabolic stimulus.     

Computation of trunk equilibrium and stability in free flexion-extension movements at different velocities

Velocity of movement has been suggested as a risk factor for low-back disorders. The effect of changes in velocity during unconstrained flexion-extension movements on muscle activations, spinal loads, base reaction forces and system stability was computed. In vivo measurements of kinematics and ground reaction forces were initially carried out on young asymptomatic subjects. The collected kinematics of three subjects representing maximum, mean and minimum lumbar rotations were subsequently used in the kinematics-driven model to compute results during the entire movements at three different velocities. Estimated spinal loads and muscle forces were significantly larger in fastest pace as compared to slower ones indicating the effect of inertial forces. Spinal stability was improved in larger trunk flexion angles and fastest movement. Partial or full flexion relaxation of global extensor muscles occurred only in slower movements. Some local lumbar muscles, especially in subjects with larger lumbar flexion and at slower paces, also demonstrated flexion relaxation. Results confirmed the crucial role of movement velocity on spinal biomechanics. Predictions also demonstrated the important role on response of the magnitude of peak lumbar rotation and its temporal variation.     

Effects of lumbo-pelvic rhythm on trunk muscle forces and disc loads during forward flexion: A combined musculoskeletal and finite element simulation study

Previous in-vivo studies suggest that the ratio of total lumbar rotation over pelvic rotation (lumbo-pelvic rhythm) during trunk sagittal movement is essential to evaluate spinal loads and discriminate between low back pain and asymptomatic population. Similarly, there is also evidence that the lumbo-pelvic rhythm is key for evaluation of realistic muscle and joint reaction forces and moments predicted by various computational musculoskeletal models. This study investigated the effects of three lumbo-pelvic rhythms defined based on in-vivo measurements on the spinal response during moderate forward flexion (60°) using a combined approach of musculoskeletal modeling of the upper body and finite element model of the lumbosacral spine. The muscle forces and joint loads predicted by the musculoskeletal model, together with the gravitational forces, were applied to the finite element model to compute the disc force and moment, intradiscal pressure, annular fibers strain, and load-sharing. The results revealed that a rhythm with high pelvic rotation and low lumbar flexion involves more global muscles and increases the role of the disc in resisting spinal loads, while its counterpart, with low pelvic rotation, recruits more local muscles and engages the ligaments to lower the disc loads. On the other hand, a normal rhythm that has balanced pelvic and lumbar rotations yields almost equal disc and ligament load-sharing and results in more balanced synergy between global and local muscles. The lumbo-pelvic rhythm has less effect on the intradiscal pressure and annular fibers strain. This work demonstrated that the spinal response during forward flexion is highly dependent on the lumbo-pelvic rhythm. It is therefore, essential to adapt this parameter instead of using the default values in musculoskeletal models for accurate prediction of muscle forces and joint reaction forces and moments. The findings provided by this work are expected to improve knowledge of spinal response during forward flexion, and are clinically relevant towards low back pain treatment and disc injury prevention.     

Torso flexion modulates stiffness and reflex response.

Neuromuscular factors that contribute to spinal stability include trunk stiffness from passive and active tissues as well as active feedback from reflex response in the paraspinal muscles. Trunk flexion postures are a recognized risk factor for occupational low-back pain and may influence these stabilizing control factors. Sixteen healthy adult subjects participated in an experiment to record trunk stiffness and paraspinal muscle reflex gain during voluntary isometric trunk extension exertions. The protocol was designed to achieve trunk flexion without concomitant influences of external gravitational moment, i.e., decouple the effects of trunk flexion posture from trunk moment. Systems identification analyses identified reflex gain by quantifying the relation between applied force disturbances and time-dependent EMG response in the lumbar paraspinal muscles. Trunk stiffness was characterized from a second order model describing the dynamic relation between the force disturbances versus the kinematic response of the torso. Trunk stiffness increased significantly with flexion angle and exertion level. This was attributed to passive tissue contributions to stiffness. Reflex gain declined significantly with trunk flexion angle but increased with exertion level. These trends were attributed to correlated changes in baseline EMG recruitment in the lumbar paraspinal muscles. Female subjects demonstrated greater reflex gain than males and the decline in reflex gain with flexion angle was greater in females than in males. Results reveal that torso flexion influences neuromuscular factors that control spinal stability and suggest that posture may contribute to the risk of instability injury.     

Relationship between reaction time of eye movement and activity of the neck extensors

This study investigated the relationship between the reaction time of eye movement (RTEM) and activity of the superficial neck extensor muscles when the shoulder girdle elevator muscles contracted isometrically. The results were compared with those of a previous study in which the subjects's head was fixed and loaded with the neck flexed. When the shoulder girdle elevator muscles contracted isometrically, RTEM decreased significantly in comparison to RTEM at rest. This demonstrated that the reaction time significantly decreased not only as a result of the neck in flexion, which activated the deep and superficial neck extensor muscles, but also from contraction of the shoulder girdle elevator muscles which mainly activated the superficial extensor muscles. The relationship between RTEM and relative muscle load of the shoulder girdle elevator muscles showed that RTEM decreased up to 30% loading, and with loading above 40% the RTEM was longer than with 30%. The relative muscle load for the shortest RTEM demonstrated a subject-to-subject variance ranging from 24.7% to 49.6%. The difference between RTEM at rest and at their shortest reaction time was approximately 20 ms, which was consistent with the data for the neck in flexion. However, the relative muscle load for the shortest RTEM differed between the current and previous studies. The parameters obtained in this study were higher than for those in the previous study.