Effects of Perturbations to Balance on Neuromechanics of Fast Changes in Direction during Locomotion

This study investigated whether the modular control of changes in direction while running is influenced by perturbations to balance. Twenty-two healthy men performed 90° side-step unperturbed cutting manoeuvres while running (UPT) as well as manoeuvres perturbed at initial contact (PTB, 10 cm translation of a moveable force platform). Surface EMG activity from 16 muscles of the supporting limb and trunk, kinematics, and ground reaction forces were recorded. Motor modules composed by muscle weightings and their respective activation signals were extracted from the EMG signals by non-negative matrix factorization. Knee joint moments, co-contraction ratios and co-contraction indexes (hamstrings/quadriceps) and motor modules were compared between UPT and PTB. Five motor modules were enough to reconstruct UPT and PTB EMG activity (variance accounted for UPT  = 92±5%, PTB = 90±6%). Moreover, higher similarities between muscle weightings from UPT and PTB (similarity = 0.83±0.08) were observed in comparison to the similarities between the activation signals that drive the temporal properties of the motor modules (similarity = 0.71±0.18). In addition, the reconstruction of PTB EMG from fixed muscle weightings from UPT resulted in higher reconstruction quality (82±6%) when compared to reconstruction of PTB EMG from fixed activation signals from UPT (59±11%). Perturbations at initial contact reduced knee abduction moments (7%), as well as co-contraction ratio (11%) and co-contraction index (12%) shortly after the perturbation onset. These changes in co-contraction ratio and co-contraction index were caused by a reduced activation of hamstrings that was also verified in the activation signals of the specific motor module related to initial contact. Our results suggested that perturbations to balance influence modular control of cutting manoeuvres, especially the temporal properties of muscle recruitment, due to altered afferent inputs to the motor patterns. Furthermore, reduced knee stability during perturbed events may be related to overall control of lower limb muscles.     

Strategies of muscular support of varus and valgus isometric loads at the human knee

In this paper we studied how subjects activate their muscles in response to static varus and valgus loads at the knee. The muscles' contributions to the external moments were estimated using an EMG driven biomechanical model of the knee. The individual muscle activation and loading patterns were examined to identify the strategies that the nervous system uses to support varus and valgus knee moments. It was found that the (1) co-contraction of the hamstrings and quadriceps, and (2) activation of the gracilis and tensor fascia lata increased with the increasing magnitude of the varus and valgus moments. These 2 activation patterns provided positive support of valgus and varus loads at the knee The sartorius appears to be activated to provide positive support of valgus loads at the knee, whereas during varus moments this muscle increases the varus load on the knee, i.e. provides negative support. Generally, the hamstrings and quadriceps co-contraction contributed to most of the muscular support of the varus and valgus moments. In addition, co-contraction supported 11-14% of the external moment in pure varus and pure valgus respectively. It appears that there are activation strategies with the specific purpose to support varus and valgus moments, albeit small, which suggest dual goals of the neuromotor system during the support of varus and valgus moments.     

Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle

There is some debate in the literature regarding the role of quadriceps-hamstrings co-contraction in the onset and progression of knee osteoarthritis. Does co-contraction during walking increase knee contact loads, thereby causing knee osteoarthritis, or might it be a compensatory mechanism to unload the medial tibial condyle? We used a detailed musculoskeletal model of the lower limb to test the hypothesis that selective activation of lateral hamstrings and quadriceps, in conjunction with inhibited medial gastrocnemius, can actually reduce the joint contact force on the medial compartment of the knee, independent of changes in kinematics or external forces. “Baseline” joint loads were computed for eight subjects with moderate medial knee osteoarthritis (OA) during level walking, using static optimization to resolve the system of muscle forces for each subject?s scaled model. Holding all external loads and kinematics constant, each subject?s model was then perturbed to represent non-optimal “OA-type” activation based on mean differences detected between electromyograms (EMG) of control and osteoarthritis subjects. Knee joint contact forces were greater for the “OA-type” than the “Baseline” distribution of muscle forces, particularly during early stance. The early-stance increase in medial contact load due to the “OA-type” perturbation could implicate this selective activation strategy as a cause of knee osteoarthritis. However, the largest increase in the contact load was found at the lateral condyle, and the “OA-type” lateral activation strategy did not increase the overall (greater of the first or second) medial peak contact load. While “OA-type” selective activation of lateral muscles does not appear to reduce the medial knee contact load, it could allow subjects to increase knee joint stiffness without any further increase to the peak medial contact load.     

Muscle activation profiles about the knee during Tai-Chi stepping movement compared to the normal gait step.

The purpose of this study was to investigate knee muscle activity patterns in experienced Tai-Chi (TC) practitioners during normal walking and TC stepping. The electromyographic (EMG) activity of vastus lateralis (VL), vastus medialis (VM), bicep femoris (BF), and gastrocnemius (GS) muscles of 11 subjects (five females and six males) during the stance phase of normal walking was compared to stance phase of a TC step. Knee joint motion was also monitored by using an Optotrak motion analysis system. Raw EMG was processed by root-mean-square (RMS) technique using a time constant of 50 ms, and normalized to maximum of voluntary contraction for each muscle, referred to as normalized RMS (nRMS). Peak nRMS and co-contraction (quantified by co-contraction index) during stance phase of a gait cycle and a TC step were calculated. Paired t-tests were used to compare the difference for each muscle group peak and co-contraction pair between the tasks. The results showed that only peak values of nRMS in quadriceps and co-contraction were significantly greater in TC stepping compared to normal walking (Peak values of nRMS for VL were 26.93% for normal walking and 52.14% for TC step, p=0.001; VM are 29.12% for normal walking and 51.93% for TC stepping, p=0.028). Mean co-contraction index for VL-BF muscle pairs was 13.24+/-11.02% during TC stepping and 9.47+/-7.77% in stance phase of normal walking (p=0.023). There was no significant difference in peak values of nRMS in the other two muscles during TC stepping compared to normal walking. Preliminary EMG profiles in this study demonstrated that experienced TC practitioners used relatively higher levels of knee muscle activation patterns with greater co-contraction during TC exercise compared to normal walking.     

Responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects

PurposeTo compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects.ScopeNine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions.ResultsPerturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait.ConclusionsHealthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.     

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (?39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (?6.4% and ?4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by ?1°. Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.     

Neuromechanical control of the forearm muscles during gripping with sudden flexion and extension wrist perturbations

The purpose of this study was to investigate how gripping modulates forearm muscle co-contraction prior to and during sudden wrist perturbations. Ten males performed a sub-maximal gripping task (no grip, 5% and 10% of maximum) while a perturbation forced wrist flexion or extension. Wrist joint angles and activity from 11 muscles were used to determine forearm co-contraction and muscle contributions to wrist joint stiffness. Co-contraction increased in all pairs as grip force increased (from no grip to 10% grip), corresponding to a 36% increase in overall wrist joint stiffness. Inclusion of individual muscle contributions to wrist joint stiffness enhanced the understanding of forearm co-contraction. The extensor carpi radialis longus (ECRL) and brevis had the largest stiffness contributions (34.5 ± 1.3% and 20.5 ± 2.3%, respectively), yet muscle pairs including ECRL produced the lowest co-contraction. The muscles contributing most to wrist stiffness were consistent across conditions (ECRL for extensors; Flexor Digitorum Superficialis for flexors), suggesting enhanced contributions rather than muscular redistribution. This work provides investigation of the neuromuscular response to wrist perturbations and gripping demands by considering both co-contraction and muscle contributions to joint stiffness. Individual muscle stiffness contributions can be used to enhance the understanding of forearm muscle control during complex tasks.     

Experimental quadriceps muscle pain impairs knee joint control during walking.

Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects. Isotonic saline (0.9%) was used as control. Surface electromyography (EMG) recordings of VM, vastus lateralis (VL), biceps femoris, and semitendinosus muscles were synchronized with the gait analyses. During experimental muscle pain, the loading response phase peak knee extensor moments were attenuated, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity of musculoskeletal problems, and it may have clinically important implications for rehabilitation and training of patients with knee pain of musculoskeletal origin.     

Extension of a state-of-the-art optimization criterion to predict co-contraction

Most studies concerned with the prediction of muscle forces have tried to predict a physiologically reasonable, synergistic muscle behavior. In addition to the load sharing of synergistic muscles, co-contraction of antagonistic muscles also occurs. An extension to a standard quadratic criterion for the calculation of muscle forces is presented in this study. This extension however is not limited to quadratic optimization. The extension is applied to a planar, one degree of freedom model of the human knee. For this model an analytical solution is presented. With the extended criterion it was possible to predict and control the amount of co-contraction for the knee model. The enforced antagonistic muscle activity led to higher agonistic muscle activity. In the absence of an external load flexor and extensor muscles were activated. As a consequence the knee joint was preloaded. This might indicate that antagonistic muscle activity is generated to maintain or improve joint stability. In conclusion, this study presents a novel approach to predict co-contraction when using optimization techniques to determine muscle forces by introducing a shift parameter for the optimization criterion.     

Muscle and external load contribution to knee joint contact loads during normal gait

Large knee adduction moments during gait have been implicated as a mechanical factor related to the progression and severity of tibiofemoral osteoarthritis and it has been proposed that these moments increase the load on the medial compartment of the knee joint. However, this mechanism cannot be validated without taking into account the internal forces and moments generated by the muscles and ligaments, which cannot be easily measured. Previous musculoskeletal models suggest that the medial compartment of the tibiofemoral joint bears the majority of the tibiofemoral load, with the lateral compartment unloaded at times during stance. Yet these models did not utilise explicitly measured muscle activation patterns and measurements from an instrumented prosthesis which do not portray lateral compartment unloading. This paper utilised an EMG-driven model to estimate muscle forces and knee joint contact forces during healthy gait. Results indicate that while the medial compartment does bear the majority of the load during stance, muscles provide sufficient stability to counter the tendency of the external adduction moment to unload the lateral compartment. This stability was predominantly provided by the quadriceps, hamstrings, and gastrocnemii muscles, although the contribution from the tensor fascia latae was also significant. Lateral compartment unloading was not predicted by the EMG-driven model, suggesting that muscle activity patterns provide useful input to estimate muscle and joint contact forces.     

Muscular co-contraction during walking and landing from a jump: comparison between genders and influence of activity level.

BACKGROUND: Women have higher rates of knee ligament injury than men. Co-contraction of knee muscles is proposed to be an important mechanism to protect the joint from injuries. HYPOTHESIS: Females have lower co-contraction levels when compared to males. STUDY DESIGN: Exploratory, cross-sectional design. METHODS: Thirty-six men and women equally divided into four groups according to gender and activity level (sedentary and athletic) were compared in relation to vastus lateralis and biceps femoris co-contraction before heel strike during level walking and before floor contact during landing from a jump. Muscular co-contraction was assessed by surface electromyography. Correlations between co-contraction and ligament laxity, extensor and flexor work, and flexion/extension torque ratio were also analyzed. RESULTS: No differences between genders were found in the studied situations (p0.381). During walking, co-contraction was greater in sedentary women compared to athletic women (p=0.002). A moderate inverse correlation was found between co-contraction during walking and women extensor (r=-0.613; p=0.007) and flexor (r=-0.575; p=0.012) work. During landing from a jump, no variables correlated to co-contraction in any of the groups tested (r0.477; p0.061). CONCLUSION: Co-contraction levels were not different between genders. Results suggest that women compensate strength deficits by means of increasing activation levels, possibly to generate adequate joint stiffness to meet stabilization demands. However, this is not evident in a more stressful activity like landing from a jump. CLINICAL RELEVANCE: This study contributes to a better understanding of the factors related to joint protection in females, who are at a greater risk of ligament injuries.     

An EMG-driven musculoskeletal model to estimate muscle forces and knee joint moments in vivo

This paper examined if an electromyography (EMG) driven musculoskeletal model of the human knee could be used to predict knee moments, calculated using inverse dynamics, across a varied range of dynamic contractile conditions. Muscle-tendon lengths and moment arms of 13 muscles crossing the knee joint were determined from joint kinematics using a three-dimensional anatomical model of the lower limb. Muscle activation was determined using a second-order discrete non-linear model using rectified and low-pass filtered EMG as input. A modified Hill-type muscle model was used to calculate individual muscle forces using activation and muscle tendon lengths as inputs. The model was calibrated to six individuals by altering a set of physiologically based parameters using mathematical optimisation to match the net flexion/extension (FE) muscle moment with those measured by inverse dynamics. The model was calibrated for each subject using 5 different tasks, including passive and active FE in an isokinetic dynamometer, running, and cutting manoeuvres recorded using three-dimensional motion analysis. Once calibrated, the model was used to predict the FE moments, estimated via inverse dynamics, from over 200 isokinetic dynamometer, running and sidestepping tasks. The inverse dynamics joint moments were predicted with an average R(2) of 0.91 and mean residual error of approximately 12 Nm. A re-calibration of only the EMG-to-activation parameters revealed FE moments prediction across weeks of similar accuracy. Changing the muscle model to one that is more physiologically correct produced better predictions. The modelling method presented represents a good way to estimate in vivo muscle forces during movement tasks.     

Trunk Muscle Activity Is Modified in Osteoporotic Vertebral Fracture and Thoracic Kyphosis with Potential Consequences for Vertebral Health

This study explored inter-relationships between vertebral fracture, thoracic kyphosis and trunk muscle control in elderly people with osteoporosis. Osteoporotic vertebral fractures are associated with increased risk of further vertebral fractures; but underlying mechanisms remain unclear. Several factors may explain this association, including changes in postural alignment (thoracic kyphosis) and altered trunk muscle contraction patterns. Both factors may increase risk of further fracture because of increased vertebral loading and impaired balance, which may increase falls risk. This study compared postural adjustments in 24 individuals with osteoporosis with and without vertebral fracture and with varying degrees of thoracic kyphosis. Trunk muscle electromyographic activity (EMG) associated with voluntary arm movements was recorded and compared between individuals with and without vertebral fracture, and between those with low and high thoracic kyphosis. Overall, elderly participants in the study demonstrated co-contraction of the trunk flexor and extensor muscles during forwards arm movements, but those with vertebral fractures demonstrated a more pronounced co-contraction than those without fracture. Individuals with high thoracic kyphosis demonstrated more pronounced alternating flexor and extensor EMG bursts than those with less kyphosis. Co-contraction of trunk flexor and extensor muscles in older individuals contrasts the alternating bursts of antagonist muscle activity in previous studies of young individuals. This may have several consequences, including altered balance efficacy and the potential for increased compressive loads through the spine. Both of these outcomes may have consequences in a population with fragile vertebrae who are susceptible to fracture.     

Reliability of surface electromyographic recordings during walking in individuals with knee osteoarthritis

To determine test–retest reliability of a surface electromyographic protocol designed to measure knee joint muscle activation during walking in individuals with knee osteoarthritis (OA). Twenty-one individuals with moderate medial compartment knee OA completed two gait data collections separated by approximately 1 month. Using a standardized protocol, surface electromyograms from rectus femoris plus lateral and medial sites for the gastrocnemii, vastii and hamstring muscles were recorded during walking. After full-wave rectification and low pass filtering, time and amplitude normalized (percent of maximum) waveforms were calculated. Principal component analysis (PP-scores) and co-contraction indices (CCI) were calculated from the waveforms. Intraclass correlation coefficients (ICC_2,k) were calculated for PP-scores and CCI’s. No differences in walking speed, knee muscle strength and symptoms were found between visits (p > 0.05). The majority of PP-scores (17 of 21) and two of four CCIs demonstrated ICC_2,k values greater than 0.81. Remaining PP-scores and CCIs had ICC_2,k values between 0.61 and 0.80. The results support that reliable EMG characteristics can be captured from a moderate knee OA patient population using a standardized protocol.     

Walking on high heels changes muscle activity and the dynamics of human walking significantly

The aim of the study was to investigate the distribution of net joint moments in the lower extremities during walking on high-heeled shoes compared with barefooted walking at identical speed. Fourteen female subjects walked at 4 km/h across three force platforms while they were filmed by five digital video cameras operating at 50 frames/second. Both barefooted walking and walking on high-heeled shoes (heel height: 9 cm) were recorded. Net joint moments were calculated by 3D inverse dynamics. EMG was recorded from eight leg muscles. The knee extensor moment peak in the first half of the stance phase was doubled when walking on high heels. The knee joint angle showed that high-heeled walking caused the subjects to flex the knee joint significantly more in the first half of the stance phase. In the frontal plane a significant increase was observed in the knee joint abductor moment and the hip joint abductor moment. Several EMG parameters increased significantly when walking on high-heels. The results indicate a large increase in bone-on-bone forces in the knee joint directly caused by the increased knee joint extensor moment during high-heeled walking, which may explain the observed higher incidence of osteoarthritis in the knee joint in women as compared with men.     

Agreement of measured and calculated muscle activity during highly dynamic movements modelled with a spherical knee joint

The inclusion of muscle forces into the analysis of joint contact forces has improved their accuracy. But it has not been validated if such force and activity calculations are valid during highly dynamic multidirectional movements. The purpose of this study was to validate calculated muscle activation of a lower extremity model with a spherical knee joint for running, sprinting and 90°-cutting. Kinematics, kinetics and lower limb muscle activation of ten participants were investigated in a 3D motion capture setup including EMG. A lower extremity rigid body model was used to calculate the activation of these muscles with an inverse dynamics approach and a cubic cost function. Correlation coefficients were calculated to compare measured and calculated activation. The results showed good correlation of the modelled and calculated data with a few exceptions. The highest average correlations were found during walking (r = 0.81) and the lowest during cutting (r = 0.57). Tibialis anterior had the lowest average correlation (r = 0.33) over all movements while gastrocnemius medius had the highest correlation (r = 0.9). The implementation of a spherical knee joint increased the agreement between measured and modelled activation compared to studies using a hinge joint knee. Although some stabilizing muscles showed low correlations during dynamic movements, the investigated model calculates muscle activity sufficiently.     

Are hamstrings activated to counteract shear forces during isometric knee extension efforts in healthy subjects?

The hamstring muscles have the potential to counteract anterior shear forces at the knee joint by co-contracting during knee extension efforts. Such a muscle recruitment pattern might protect the anterior cruciate ligament (ACL) by reducing its strain. In this study we investigated to what extent co-activation of the knee flexors during extension efforts is compatible with the hypothesis that this co-activation serves to counteract anterior tibial shear forces during isometric knee extension efforts in healthy subjects. To this aim, it is investigated whether co-activation varies with the required knee extension moment, with the knee joint angle, and with the position of the external flexing force relative to the knee joint. With unaltered moment and muscle activation, distal positioning of the flexing force on the tibia causes higher resultant (muscular plus external) forward shear forces at the knee as compared to proximal positioning. In ten subjects, knee flexor and extensor EMG was measured during a quasi-isometric positioning task for a range (5-50 degrees) of knee flexion angles. It was found that the co-activation of the knee flexors increased with the extension moment, but this increase was less than proportional (p<0.001). The extension moment increased 2.7 to 3.4 times, whereas the activation of Biceps Femoris and Semitendinosus increased only a factor 1.3 to 2.0 (joint angle dependent). Furthermore, a strong increase in co-activation was seen near full extension of the knee joint. The position of the external extension load on the tibia did not affect the level of co-contraction. It is argued that these results do not suggest a recruitment pattern that is directed at reduction of anterior shear forces in the knee joint during sub-maximal isometric knee extension efforts in healthy subjects.     

Co-contraction during static and dynamic knee extensions in ACL deficient subjects.

Co-contraction of the muscles is proposed in the literature as one of the strategies that anterior cruciate ligament deficient (ACLD) subjects can use to compensate the loss of ACL function. This study examined the response of ACLD and control subjects to different shear forces in isometric and slow-dynamic knee extensions. Twelve chronic ACLD and 10 control subjects performed submaximal positioning and slow-dynamic knee extensions (between 45 degrees and 5 degrees of knee flexion) with two external flexion moments both applied at two distances on the lower leg. The shear force was controlled by changing the moment arm without changing the moment. Electromyographic data were collected from knee flexor and extensor muscles. In the analysis of variance, no significant effect of subject group was found in positioning or slow-dynamic tasks across all muscles. The effect of knee angle was significantly different between the subject groups for biceps femoris in positioning and for rectus femoris in slow-dynamic tasks, but these effects were very small and will not have a great impact on the resulting shear forces. There was no interaction between moment arm and subject group. Therefore, the hypothesis that ACLD subjects increase co-contraction in situations with an increased shear load in positioning and slow-dynamic knee extensions could not be confirmed.     

Active trunk stiffness increases with co-contraction.

Trunk dynamics, including stiffness, mass and damping were quantified during trunk extension exertions with and without voluntary recruitment of antagonistic co-contraction. The objective of this study was to empirically evaluate the influence of co-activation on trunk stiffness. Muscle activity associated with voluntary co-contraction has been shown to increase joint stiffness in the ankle and elbow. Although biomechanical models assume co-active recruitment causes increase trunk stiffness it has never been empirically demonstrated. Small trunk displacements invoked by pseudorandom force disturbances during trunk extension exertions were recorded from 17 subjects at two co-contraction conditions (minimal and maximal voluntary co-contraction recruitment). EMG data were recorded from eight trunk muscles as a baseline measure of co-activation. Increased EMG activity confirms that muscle recruitment patterns were different between the two co-contraction conditions. Trunk stiffness was determined from analyses of impulse response functions (IRFs) of trunk dynamics wherein the kinematics were represented as a second-order behavior. Trunk stiffness increased 37.8% (p < 0.004) from minimal to maximal co-activation. Results support the assumption used in published models of spine biomechanics that recruitment of trunk muscle co-contraction increases trunk stiffness thereby supporting conclusions from those models that co-contraction may contribute to spinal stability.