Spinal stability and role of passive stiffness in dynamic squat and stoop lifts

The spinal stability and passive-active load partitioning under dynamic squat and stoop lifts were investigated as the ligamentous stiffness in flexion was altered. Measured in vivo kinematics of subjects lifting 180 N at either squat or stoop technique was prescribed in a nonlinear transient finite element model of the spine. The Kinematics-driven approach was utilized for temporal estimation of muscle forces, internal spinal loads and system stability. The finite element model accounted for nonlinear properties of the ligamentous spine, wrapping of thoracic extensor muscles and trunk dynamic characteristics while subject to measured kinematics and gravity/external loads. Alterations in passive properties of spine substantially influenced muscle forces, spinal loads and system stability in both lifting techniques, though more so in stoop than in squat. The squat technique is advocated for resulting in smaller spinal loads. Stability of spine in the sagittal plane substantially improved with greater passive properties, trunk flexion and load. Simulation of global extensor muscles with curved rather than straight courses considerably diminished loads on spine and increased stability throughout the task.     

Posture-dependent trunk extensor EMG activity during maximum isometrics exertions in normal male and female subjects.

Posture-dependent trunk function data are important for appropriate normalization of submaximal trunk exertions, and is also necessary to define a more precise and specific use for strength testing in the prevention and diagnosis of spinal disorders. The aim of the current study was to quantify maximal effort trunk muscle extensor activity and trunk isometric extension torque over a functional range of sagittal standing postures. Twenty healthy, young adult male and female subjects performed isometric extension tasks over a sagittal posture range of -20 degrees extension to +50 degrees flexion, in 10 degrees increments. Erector spinae muscle activity was recorded bilaterally at the level of L3 using surface EMG electrodes. Isometric trunk extension torque was measured using a trunk dynamometer. EMG and trunk torque differed significantly between genders, but there were no differences between male and female subjects when the data were normalized with respect to the upright posture. For the combined male and female population, upright posture normalized L3 EMG activity (EMGn) and trunk extension torque (Tn) increased 1.7-fold and 3.5-fold, respectively, over the 70 degrees range of sagittal postures examined. The ratio (Tn/EMGn) increased two-fold (0.83 to 1.67) from -20 degrees extension to +50 degrees flexion, indicating that the neuromuscular efficiency increases with flexion. Trunk extension torque normalized with respect to the upright posture was linearly and positively correlated (r = 0.59, P < 0.001) to similarly normalized L3 EMG activity. This relatively weak correlation suggests that trunk muscle synergism and/or intrinsic muscle length-tension relationships are also modulated by posture. This study provides data that can be used to estimate trunk extensor muscle function over a broad range of sagittal postures. Our findings indicate that appropriate postural normalization of trunk extensor EMG activity is necessary for studies where submaximal trunk exertions are performed over a range of upright postures.     

Influence of knee angle and individual flexibility on the flexion-relaxation response of the low back musculature.

In many occupational settings (e.g. agriculture and construction) workers are asked to maintain static flexed postures of the low back for extended periods of time. Recent research indicates that the resulting strain in the viscoelastic, ligamentous tissues may have a deleterious effect on the stability of the spine and the normal reflex response of spinal tissues. The purpose of this study was to evaluate the previously described flexion-relaxation response in terms of the interactive effect of trunk flexion angle (30 degrees, 50 degrees, 70 degrees, 90 degrees ), knee flexion angle (0 degrees (straight knees), 20 degrees, 40 degrees ) and individual flexibiliteky (low, medium, and high). These conditions were tested under two levels of loading: no load (just supporting the weight of the torso) and trunk extension moment equal to 50% of the subject's posture-specific maximum voluntary trunk extension capacity. Surface electromyographic (EMG) data were collected from the multifidus, the longissimus, the iliocostalis, the vastus medialis, the rectus femoris, the vastus lateralis, the biceps femoris, and the gastrocnemius-soleus group from a sample of eight male participants as they performed isometric weight holding tasks in the postures defined by the combinations of trunk angle and knee angle. The results of this study showed that knee angle did have a significant effect on the lumbar extensor muscle activity but only consistently at the 90 degrees trunk angle. Participant flexibility showed a consistent trend of decreasing lumbar extensor muscle activity with decreased flexibility across all trunk angle values. Most interesting was the interactive response of flexibility and knee angle, wherein the flexibility of the participant influenced the trunk angles at which the knee flexion angle affected the flexion-relaxation response. Highly flexible subjects showed an effect of knee angle on the flexion-relaxation response only at the 90 degrees trunk angle; subjects in the medium flexibility category showed a similar response in both the 70 degrees and 90 degrees trunk angles; subject in the low flexibility group showed no knee angle effect on the flexion-relaxation response. Overall the results confirm previous results with regard to the contribution of the passive tissues to the overall trunk extension moment but also show that the tension in the bi-articular biceps femoris, which was influenced by knee flexion angle and flexibility, affects the ratio of active extensor moment contributions of the lumbar extensor musculature to passive extensor moment contributions from the muscular and ligamentous tissues. The results of this study provide empirical data describing this complicated, interactive response.     

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.     

Trunk response analysis under sudden forward perturbations using a kinematics-driven model

Accurate quantification of the trunk transient response to sudden loading is crucial in prevention, evaluation, rehabilitation and training programs. An iterative dynamic kinematics-driven approach was used to evaluate the temporal variation of trunk muscle forces, internal loads and stability under sudden application of an anterior horizontal load. The input kinematics is hypothesized to embed basic dynamic characteristics of the system that can be decoded by our kinematics-driven approach. The model employs temporal variation of applied load, trunk forward displacement and surface EMG of select muscles measured on two healthy and one chronic low-back pain subjects to a sudden load. A finite element model accounting for measured kinematics, nonlinear passive properties of spine, detailed trunk musculature with wrapping of global extensor muscles, gravity load and trunk biodynamic characteristics is used to estimate the response under measured sudden load. Results demonstrate a delay of ～200 ms in extensor muscle activation in response to sudden loading. Net moment and spinal loads substantially increase as muscles are recruited to control the trunk under sudden load. As a result and due also to the trunk flexion, system stability significantly improves. The reliability of the kinematics-driven approach in estimating the trunk response while decoding measured kinematics is demonstrated. Estimated large spinal loads highlight the risk of injury that likely further increases under larger perturbations, muscle fatigue and longer delays in activation.     

Investigation of the Differential Contributions of Superficial and Deep Muscles on Cervical Spinal Loads with Changing Head Postures

Cervical spinal loads are predominately influenced by activities of cervical muscles. However, the coordination between deep and superficial muscles and their influence on the spinal loads is not well understood. This study aims to document the changes of cervical spinal loads and the differential contributions of superficial and deep muscles with varying head postures. Electromyography (EMG) of cervical muscles from seventeen healthy adults were measured during maximal isometric exertions for lateral flexion (at 10°, 20° and terminal position) as well as flexion/extension (at 10°, 20°, 30°, and terminal position) neck postures. An EMG-assisted optimization approach was used to estimate the muscle forces and subsequent spinal loads. The results showed that compressive and anterior-posterior shear loads increased significantly with neck flexion. In particular, deep muscle forces increased significantly with increasing flexion. It was also determined that in all different static head postures, the deep muscle forces were greater than those of the superficial muscle forces, however, such pattern was reversed during peak efforts where greater superficial muscle forces were identified with increasing angle of inclination. In summary, the identification of significantly increased spinal loads associated with increased deep muscle activation during flexion postures, implies higher risks in predisposing the neck to occupationally related disorders. The results also explicitly supported that deep muscles play a greater role in maintaining stable head postures where superficial muscles are responsible for peak exertions and reinforcing the spinal stability at terminal head postures. This study provided quantitative data of normal cervical spinal loads and revealed motor control strategies in coordinating the superficial and deep muscles during physical tasks.     

Magnitude of forward trunk flexion influences upper limb muscular efforts and dynamic postural stability requirements during sitting pivot transfers in individuals with spinal cord injury

The purpose of this study was to investigate the effects of imposing different degrees of forward trunk flexion during sitting pivot transfers on electromyographic activity at the leading and trailing upper limb muscles and on dynamic stability requirements. Thirty-two individuals with a spinal cord injury performed three types of sitting pivot transfers: natural technique, exaggerated forward trunk flexion and upright trunk position. Ground reaction forces, trunk kinematics, and bilateral electromyographic activity of eight upper limb muscles were recorded. Electromyographic data were analyzed using the area under the curve of the muscular utilization ratio. Dynamic stability requirements of sitting pivot transfers were assess using a dynamic equilibrium model. Compared to the natural strategy, significantly greater muscle activities were found for the forward trunk flexion condition at the anterior deltoid and both heads of the pectorialis major, whereas the upright trunk strategy yielded greater muscle activity at the latissimus dorsii and the triceps. The forward flexed condition was found to be more dynamically stable, with a lower stabilizing force, increased area of base of support and greater distance traveled. Thus, transferring with a more forward trunk inclination, even though it increases work of few muscles, may be a beneficial trade-off because increased dynamic stability of this technique and versatility in terms of potential distance of the transfer.     

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.     

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.     

A comparative study of two trunk biomechanical models under symmetric and asymmetric loadings

Despite recent advances in modeling of the human spine, simplifying assumptions are still required to tackle complexities. Such assumptions need to be scrutinized to assess their likely impacts on predictions. A comprehensive comparison of muscle forces and spinal loads estimated by a single-joint (L5–S1) optimisation-assisted EMG-driven (EMGAO) and a multi-joint Kinematics-driven (KD) model of the spine under symmetric (symmetric trunk flexion from neutral upright to maximum forward flexion) and asymmetric (holding a load at various heights in the right hand) activities is carried out. Regardless of the task simulated, the KD model predicted greater activities in extensor muscles as compared to the EMGAO model. Such differences in the symmetric tasks was due mainly to the distinct approaches to resolve the redundancy while in the asymmetric tasks they were due also to the different methods used to estimate joint moments. Shear and compression forces were generally higher in the KD model. Differences in predictions between these modeling approaches varied depending on the task simulated and the joint considered in the single-joint EMGAO model. The EMGAO model should incorporate a multi-joint strategy to satisfy equilibrium at different levels while the KD model should benefit from recorded EMG activities of the antagonistic muscles to supplement input measured kinematics.     

Seated whole body vibrations with high-magnitude accelerations--relative roles of inertia and muscle forces

Reliable computation of spinal loads and trunk stability under whole body vibrations with high acceleration contents requires accurate estimation of trunk muscle activities that are often overlooked in existing biodynamic models. A finite element model of the spine that accounts for nonlinear load- and direction-dependent properties of lumbar segments, complex geometry and musculature of the spine, and dynamic characteristics of the trunk was used in our iterative kinematics-driven approach to predict trunk biodynamics in measured vehicle's seat vibrations with shock contents of about 4g (g: gravity acceleration of 9.8m/s(2)) at frequencies of about 4 and 20Hz. Muscle forces, spinal loads and trunk stability were evaluated for two lumbar postures (erect and flexed) with and without coactivity in abdominal muscles. Estimated peak spinal loads were substantially larger under 4Hz excitation frequency as compared to 20Hz with the contribution of muscle forces exceeding that of inertial forces. Flattening of the lumbar lordosis from an erect to a flexed posture and antagonistic coactivity in abdominal muscles, both noticeably increased forces on the spine while substantially improving trunk stability. Our predictions clearly demonstrated the significant role of muscles in trunk biodynamics and associated risk of back injuries. High-magnitude accelerations in seat vibration, especially at near-resonant frequency, expose the vertebral column to large forces and high risk of injury by significantly increasing muscle activities in response to equilibrium and stability demands.     

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.     

A comparison of lumbar spine and muscle loading between male and female workers during box transfers

There is a clear relationship between lumbar spine loading and back musculoskeletal disorders in manual materials handling. The incidence of back disorders is greater in women than men, and for similar work demands females are functioning closer to their physiological limit. It is crucial to study loading on the spine musculoskeletal system with actual handlers, including females, to better understand the risk of back disorders. Extrapolation from biomechanical studies conducted on unexperienced subjects (mainly males) might not be applicable to actual female workers. For male workers, expertise changes the lumbar spine flexion, passive spine resistance, and active/passive muscle forces. However, experienced females select similar postures to those of novices when spine loading is critical. This study proposes that the techniques adopted by male experts, male novices, and females (with considerable experience but not categorized as experts) impact their lumbar spine musculoskeletal systems differently. Spinal loads, muscle forces, and passive resistance (muscle and ligamentous spine) were predicted by a multi-joint EMG-assisted optimization musculoskeletal model of the lumbar spine. Expert males flexed their lumbar spine less (avg. 21.9° vs 30.3–31.7°) and showed decreased passive internal moments (muscle avg. 8.9% vs 15.9–16.0%; spine avg. 4.7% vs 7.1–7.8%) and increased active internal moments (avg. 72.9% vs 62.0–63.9%), thus producing a different impact on their lumbar spine musculoskeletal systems. Experienced females sustained the highest relative spine loads (compression avg. 7.3 N/BW vs 6.2–6.4 N/BW; shear avg. 2.3 N/BW vs 1.7–1.8 N/BW) in addition to passive muscle and ligamentous spine resistance similar to novices. Combined with smaller body size, less strength, and the sequential lifting technique used by females, this could potentially mean greater risk of back injury. Workers should be trained early to limit excessive and repetitive stretching of their lumbar spine passive tissues.     

Activity of deep abdominal muscles increases during submaximal flexion and extension efforts but antagonist co-contraction remains unchanged

Lumbo-pelvic stability relies, amongst other factors, on co-contraction of the lumbo-pelvic muscles. However, during submaximal trunk flexion and extension efforts, co-contraction of antagonist muscles is limited. It was predicted that activity of the deeper lumbo-pelvic muscles that are often excluded from analysis (transversus abdominis (TrA) and the deep fascicles of multifidus (DM)), would increase with load in each direction. In eleven healthy subjects, electromyographic activity (EMG) was recorded from eight trunk muscles using surface and fine-wire electrodes. Subjects performed isometric flexion and extension efforts to submaximal loads of 50, 100, 150 and 200 N and a maximal voluntary contraction (MVC). Loading tasks were then repeated in trials in which subjects knew that the load would release at an unpredictable time. Compared to the starting position, EMG of all muscles, except DM, increased during MVC efforts in both directions. During the flexion and extension submaximal tasks, there was no increased co-contraction of antagonist muscles. However, TrA EMG increased in both directions. In the unpredictable trials, EMG of all lumbo-pelvic muscles except TrA was decreased. These findings provide further support for a contribution of TrA to lumbo-pelvic stability. In submaximal tasks, TrA activation may enhance stability as a strategy to improve trunk stiffness without requiring a concurrent increase in activity of the larger torque producing trunk muscles.     

Wrist splint effects on muscle activity and force during a handgrip task

Wrist splints are commonly prescribed to limit wrist motion and provide support at night and during inactive periods but are often used in the workplace. In theory, splinting the wrist should reduce wrist extensor muscle activity by stabilizing the joint and reducing the need for co-contraction to maintain posture. Ten healthy volunteers underwent a series of 24 10-s gripping trials with surface electromyography on 6 forearm muscles. Trials were randomized between splinted and nonsplinted conditions with three wrist postures (30 degrees flexion, neutral, and 30 degrees extension) and four grip efforts. Custom-made Plexiglas splints were taped to the dorsum of the hand and wrist. It was found that when simply holding the dynamometer, use of a splint led to a small (<1% MVE) but significant reduction in activity for all flexor muscles and extensor carpi radialis (all activity <4% maximum). At maximal grip, extensor muscle activity was significantly increased with the splints by 7.9-23.9% MVE. These data indicate that splinting at low-to-moderate grip forces may act to support the wrist against external loading, but appears counterproductive when exerting maximal forces. Wrist bracing should be limited to periods of no to light activity and avoided during tasks that require heavy efforts.     

Elevation and orientation of external loads influence trunk neuromuscular response and spinal forces despite identical moments at the L5–S1 level

A wide range of loading conditions involving external forces with varying magnitudes, orientations and locations are encountered in daily activities. Here we computed the effect on trunk biomechanics of changes in force location (two levels) and orientation (5 values) in 4 subjects in upright standing while maintaining identical external moment of 15 Nm, 30 N m or 45 Nm at the L5–S1. Driven by measured kinematics and gravity/external loads, the finite element models yielded substantially different trunk neuromuscular response with moderate alterations (up to 24% under 45 Nm moment) in spinal loads as the load orientation varied. Under identical moments, compression and shear forces at the L5–S1 as well as forces in extensor thoracic muscles progressively decreased as orientation of external forces varied from downward gravity (90°) all the way to upward (−25°) orientation. In contrast, forces in local lumbar muscles followed reverse trends. Under larger horizontal forces at a lower elevation, lumbar muscles were much more active whereas extensor thoracic muscle forces were greater under smaller forces at a higher elevation. Despite such differences in activity pattern, the spinal forces remained nearly identical (<6% under 45 Nm moment). The published recorded surface EMG data of extensor muscles trend-wise agreed with computed local muscle forces as horizontal load elevation varied but were overall different from results in both local and global muscles when load orientation altered. Predictions demonstrate the marked effect of external force orientation and elevation on the trunk neuromuscular response and spinal forces and questions attempts to estimate spinal loads based only on consideration of moments at a spinal level.     

Coupled objective function to study the role of abdominal muscle forces in lifting using the kinematics-driven model

To circumvent the existing shortcoming of optimisation algorithms in trunk biomechanical models, both agonist and antagonist trunk muscle stresses to different powers are introduced in a novel objective function to evaluate the role of abdominal muscles in trunk stability and spine compression. This coupled objective function is introduced in our kinematics-driven finite element model to estimate muscle forces and to identify the role of abdominal muscles in upright standing while lifting symmetrically a weight at different heights. Predictive equations for the compression and buckling forces are developed. Results are also compared with the conventional objective function that neglects abdominal muscle forces. An overall optimal solution involving smaller spinal compression but higher trunk stability is automatically attained when choosing muscle stress powers at and around 3. Results highlight the internal oblique muscle as the most efficient abdominal muscle during the tasks investigated. The estimated relative forces in abdominal muscles are found to be in good agreement with the respective ratios of recorded electromyography activities.     

An open-source model and solution method to predict co-contraction in the finger

A novel open-source biomechanical model of the index finger with an electromyography (EMG)-constrained static optimization solution method are developed with the goal of improving co-contraction estimates and providing means to assess tendon tension distribution through the finger. The Intrinsic model has four degrees of freedom and seven muscles (with a 14 component extensor mechanism). A novel plugin developed for the OpenSim modelling software applied the EMG-constrained static optimization solution method. Ten participants performed static pressing in three finger postures and five dynamic free motion tasks. Index finger 3D kinematics, force (5, 15, 30 N), and EMG (4 extrinsic muscles and first dorsal interosseous) were used in the analysis. The Intrinsic model predicted co-contraction increased by 29% during static pressing over the existing model. Further, tendon tension distribution patterns and forces, known to be essential to produce finger action, were determined by the model across all postures. The Intrinsic model and custom solution method improved co-contraction estimates to facilitate force propagation through the finger. These tools improve our interpretation of loads in the finger to develop better rehabilitation and workplace injury risk reduction strategies.     

Effect of load position on muscle forces, internal loads and stability of the human spine in upright postures

A novel kinematics-based approach coupled with a non-linear finite element model was used to investigate the effect of changes in the load position and posture on muscle activity, internal loads and stability margin of the human spine in upright standing postures. In addition to 397 N gravity, external loads of 195 and 380 N were considered at different lever arms and heights. Muscle forces, internal loads and stability margin substantially increased as loads displaced anteriorly away from the body. Under same load magnitude and location, adopting a kyphotic posture as compared with a lordotic one increased muscle forces, internal loads and stability margin. An increase in the height of a load held at a fixed lever arm substantially diminished system stability thus requiring additional muscle activations to maintain the same margin of stability. Results suggest the importance of the load position and lumbar posture in spinal biomechanics during various manual material handling operations.     

Sensitivity of intervertebral joint forces to center of rotation location and trends along its migration path

Translational vertebral motion during functional tasks manifests itself in dynamic loci for center of rotation (COR). A shift of COR affects moment arms of muscles and ligaments; consequently, muscle and joint forces are altered. Based on posture- and level-specific trends of COR migration revealed by in vivo dynamic radiography during functional activities, it was postulated that the instantaneous COR location for a particular joint is optimized in order to minimize the joint reaction forces. A musculoskeletal multi-body model was employed to investigate the hypotheses that (1) a posterior COR in upright standing and (2) an anterior COR in forward flexed posture leads to optimized lumbar joint loads. Moreover, it was hypothesized that (3) lower lumbar levels benefit from a more superiorly located COR.The COR in the model was varied from its initial position in posterior-anterior and inferior-superior direction up to ±6 mm in steps of 2 mm. Movement from upright standing to 45° forward bending and backwards was simulated for all configurations. Joint reaction forces were computed at levels L2L3 to L5S1. Results clearly confirmed hypotheses (1) and (2) and provided evidence for the validity of hypothesis (3), hence offering a biomechanical rationale behind the migration paths of CORs observed during functional flexion/extension movement. Average sensitivity of joint force magnitudes to an anterior shift of COR was +6 N/mm in upright and −21 N/mm in 30° forward flexed posture, while sensitivity to a superior shift in upright standing was +7 N/mm and −8 N/mm in 30° flexion. The relation between COR loci and joint loading in upright and flexed postures could be mainly attributed to altered muscle moment arms and consequences on muscle exertion. These findings are considered relevant for the interpretation of COR migration data, the development of numerical models, and could have an implication on clinical diagnosis and treatment or the development of spinal implants.