Trunk extensor fatigue influences trunk muscle activities during walking gait

Prolonged physical activities may introduce risks for low back injury due to the adapted neuromuscular response of the system once neuromuscular fatigue is present. Trunk extensor muscles were fatigued in fourteen healthy women to observe myoelectric changes in the trunk musculature during walking trials performed before and after fatigue conditions. Sub-maximal efforts at 50% and 70% maximal trunk extension effort were performed until the pre-determined levels could not be sustained. Surface electromyography (EMG) from lumbar paraspinal (LP), rectus abdominis (RA), external oblique (EO) muscles were recorded during fatigue conditions and pre and post fatigue walking trials. Infrared sensors were used to time participants as they walked. Footswitches attached to the right heel were used to record heel contacts, and were time synchronized with the EMG signals. LP and RA activity burst peaks shifted in time at contralateral heel contacts (p < 0.05) in the 70% condition, while RA amplitude increased (p < 0.05) and EO burst peak temporal shifts (p < 0.05) were present in the 50% condition. Reduced ability of the paraspinal muscles to support the trunk after fatigue onset may be a contributing factor, lending to diminished spine stiffness in attenuating ground reaction forces.     

Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury

Evidence indicates that previous low back injury (LBI) is a strong predictor for re-injury. The purpose of this study was to examine whether neuromuscular patterns remain altered in a LBI group who were deemed recovered. Surface electromyograms from 12-abdominal and 12-back extensors sites and motion variables were recorded from 33 LBI individuals (sub-acute phase) and 54 asymptomatic controls. Pain-related variables were recorded and a clinical assessment performed for LBI participants. Subjects performed a symmetrical lift and replace task in two reaches. Pattern recognition techniques were applied to normalized activation amplitude patterns to extract key recruitment strategies. Mixed model ANOVAs tested for effects (p < 0.05). Despite similar task performance, significantly (p < 0.05) different recruitment strategies were observed for the LBI group. There were higher activation amplitudes for LBI subjects in all muscles (except posterior external oblique) and greater co-activation between abdominal and back extensor sites compared to controls. Local abdominal and back extensor sites showed altered responses to increased physical demands in the LBI group. Despite outcomes indicating recovery, the LBI group had altered neuromuscular patterns compared to asymptomatic controls supporting that residual alterations remain following recovery.     

Examining the reliability of the flexor carpi radialis V-wave at different levels of muscle contraction

This study examined the reliability and scaling of the flexor carpi radialis (FCR) V-wave during submaximal and maximal voluntary muscle contractions (MVC). 23 participants were tested on three separate sessions. For each session, participants performed isometric wrist flexions at five contraction levels (20, 40, 60, 80 and 100 %MVC). When the target contraction level was reached, a supramaximal electrical stimulus was applied to the median nerve in order to elicit an FCR V-wave. Across all participants, the FCR V-wave amplitude, normalized to its superimposed M-wave amplitude, increased from 0.030 ± 0.001 to 0.143 ± 0.015 (P < 0.001) as the muscle contraction increased from 20 to 100 %MVC. Contraction level did not influence the reliability of evoking the FCR V-wave, as the V-wave demonstrated both stability and consistency. With the exception of a single day main effect during the 20 %MVC condition, V:M_sup was not different across days or trials (P > 0.05) indicating measurement stability. High reliability co-efficients (0.827–0.913) at each contraction level signified measurement consistency. This study establishes that FCR V-waves can be reliably evoked during both submaximal and maximal muscle contractions and suggests the possibility for FCR V-wave recordings to be used to document neuromuscular adaptations associated with factors such as training or fatigue.     

Tensiomyography of selected lower-limb muscles in professional soccer players

Tensiomyography is a non-invasive method of neuromuscular assessment used to measure muscle action characteristics, muscle tone, and muscle fiber type, and provides information on acute and chronic responses of muscle to different training loads. The aims of the present study were: to analyse differences in muscle response and mechanical characteristics of two major muscles of the lower extremity in a large group of Spanish soccer players according to playing position, and to provide group norms against which clinical findings may be compared. Data were collected from 78 professional soccer players (age 26.6 ± 4.4 years; height: 179.2 ± 5.3 cm; body mass: 75.8 ± 5.3 kg). Tensiomyography was recorded from the rectus femoris (RF) and biceps femoris (BF) muscles after 2 days without take part in any strenuous exercise or training. Five tensiomyographic parameters were analyzed: maximal displacement (D_m), contraction time (T_c), sustain time (T_s), delay time (T_d), and half-relaxation time (T_r). A good to excellent intra-session reliability was found for all contractile parameters (ICC ranged from 0.78 to 0.95). No significant differences between players of any position were observed in absolute values of BF. However, significant differences were observed for T_c, T_r and T_s between the different playing positions on RF (P < 0.05, effect size ranged from 1.3 to 1.6). Professional soccer players showed muscles with ability to rapidly generate force during contractions. The neuromuscular profile provided could help in identifying the normative data that are important for the different positions in order to optimize the training and recovery process of each individual player.     

The influence of water level fluctuations on the growth of four emergent macrophyte species

The influence of the amplitude of cyclic water level fluctuations on the growth of four species of emergent macrophyte (Cyperus vaginatus, Phragmites australis, Triglochin procerum and Typha domingensis) was studied in a controlled, pond-based experiment. The amplitudes of water level fluctuations were static, ±15, ±30 and ±45 cm, each cycling over a forty-day period. In all treatments the water level fluctuated around an initial water depth of 60 cm. Within each amplitude treatment, plants were grown at three elevations with the sediment surface at 20, 40 or 60 cm. Only T. domingensis and P. australis showed a significant response to amplitude. Biomass of T. domingensis was similar in the static, ±15 and ±30 cm amplitude treatments but dropped by ca. 52% when grown in amplitudes of ±45 cm. In contrast, the largest biomass for P. australis occurred in the ±30 cm amplitude treatment suggesting this species prefers moderately fluctuating water levels. The response of P. australis to amplitude was contingent upon elevation with plants growing in the ±45 cm amplitude, low elevation treatment having particularly low biomasses. C. vaginatus biomass increased with increasing elevation but did not respond to amplitude while T. procerum did not respond to either amplitude or elevation likely due to the ability of the species to photosynthesise under water. The relative growth rate and the average emergent surface area were logarithmically related in C. vaginatus suggesting flooding of the photosynthetic canopy was limiting the ability of this species to acquire atmospheric carbon. No clear relationship was found for T. domingensis or P. australis indicating that a factor other than access to atmospheric carbon was restricting the growth of these species.     

Validity of the twitch interpolation technique for the assessment of quadriceps neuromuscular asymmetries

This study examined the validity of the twitch interpolation technique for evaluating side-to-side asymmetries in quadriceps neuromuscular function. Fifty-six subjects with a wide range of asymmetries (19 healthy, 24 with unilateral and 13 with bilateral anterior cruciate ligament reconstruction) took part in the study. Supramaximal electrical paired stimuli were delivered to the quadriceps muscle during and immediately after a maximal voluntary contraction (MVC) of the knee extensors (twitch interpolation technique). MVC torque, voluntary activation and resting doublet-evoked torque were measured separately for the two sides, and percent side-to-side asymmetries were calculated for each parameter. MVC torque asymmetry was plotted against voluntary activation asymmetry and doublet-evoked torque asymmetry, and a multiple regression analysis was also conducted. Significant positive correlations were observed between MVC torque asymmetry and both voluntary activation asymmetry (r = 0.40; p = 0.002) and doublet-evoked torque asymmetry (r = 0.53; p < 0.001), and their relative contribution to MVC torque asymmetry was comparable (r = 0.64; p < 0.001). These results establish the validity of the twitch interpolation technique for the assessment of neuromuscular asymmetries. This methodology could provide useful insights into the contribution of some neural and muscular mechanisms that underlie quadriceps strength deficits.     

Stimulus–response characteristics of motor evoked potentials and silent periods in proximal and distal upper-extremity muscles

ObjectiveTo compare stimulus–response characteristics of both motor evoked potentials (MEP) and silent periods (SP) induced by transcranial magnetic stimulation (TMS) in proximal and distal upper-extremity muscles.MethodsStimulus–response curves of MEPs and SPs were obtained from the biceps brachii (BB) and abductor digiti minimi (ADM) muscles in 15 healthy participants. A nonlinear mixed model was used to fit the stimulus–response curves to a sigmoid Boltzmann function.ResultsSmall residuals of the function were found for MEPs and SPs in both muscles. Higher maximal MEP amplitudes were found for the BB compared to the ADM (p < 0.01). The active motor threshold to obtain a SP was less for the ADM compared to the BB (p < 0.01). The slope parameter of the function of the SP duration was steeper and more variable in the ADM than in the BB (p < 0.01). For the MEP amplitude no difference in active motor threshold and slope of the function was found between both muscles.ConclusionsExcitatory (MEP) and inhibitory (SP) effects of TMS differ between proximal arm and distal hand muscles in healthy participants. The adequate fit of our model suggests that this model can be used to study between and within subject changes in future studies.     

Variability of successive contractions subtracted from unfused tetanus of fast and slow motor units

Stimulation of motor units (MUs) with repeated pulses evokes tetanic contractions, which consist of overlapping mechanical responses. The summation of these responses into tetanus is a nonlinear process due to the dynamic changes in the amplitudes and time parameters of the successive components. In order to study these changes, two MUs (one fast and one slow) of rat medial gastrocnemius muscle were stimulated with a progressively increasing number of pulses, from one (i = 1) to sixteen (i = 16) at a frequency of 15 Hz for the slow MU and 60 Hz for the fast MU. The individual responses were calculated by subtracting the (i)th from the (i + 1)th tetanus recording. The contractions obtained following subtraction were modeled using a novel 6-parameter analytical function. The main conclusions of this study are (1) the newly presented analytical function is able to precisely describe the variable shape of all subtracted experimental contractions; (2) the shapes of successive contractions are variable and the subtracted contractions differ from the individual twitches; (3) as the pulse number increases, the parameters of the subtracted contractions change in a different manner for the slow and fast MUs: for the slow MU, the maximal forces and the time parameters increase considerably up to the 4th response, after which they remain nearly constant or show only a slight increase; for the fast MU, the maximal forces and durations also increase, whereas the remaining time parameters initially increase and then maintain a constant level or decrease, which explains the sag phenomenon visible in the unfused tetanus of fast MUs.     

Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain

Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion–extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β = 0.25, p = 0.006, sr² = 0.06), neuromuscular responses to experimental pain (β = −0.24, p = 0.011, sr² = 0.05), clinical pain intensity (β = 0.28, p = 0.002, sr² = 0.08) and psychological factors (β = 0.58, p < 0.001, sr² = 0.32). Together, these predictors accounted for 65% of variance in disability (R² = 0.65 p < 0.001). The current investigation revealed that neuromuscular adaptations are independent from clinical pain intensity and psychological factors, and contribute to inter-individual differences in patients’ disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations.     

Neuromuscular fatigue during a prolonged intermittent exercise: Application to tennis

The time course of alteration in neuromuscular function of the knee extensor muscles was characterized during a prolonged intermittent exercise. Maximal voluntary contraction (MVC) and surface EMG activity of both vastii were measured during brief interruptions before (T₀), during (30, 60, 90, 120, 150 and 180 min: T₃₀, T₆₀, T₉₀, T₁₂₀, T₁₅₀, T₁₈₀) and 30 min after (T₊₃₀) a 3 h tennis match in 12 trained players. M-wave and twitch contractile properties were analyzed following single stimuli. Short tetani at 20 Hz and 80 Hz were also applied to six subjects at T₀ and T₁₈₀. Significant reductions in MVC (P < 0.05; −9%) and electromyographic activity normalized to the M wave for both vastii (P < 0.01) occurred with fatigue at T₁₈₀. No significant changes in M-wave duration and amplitude nor in twitch contractile properties were observed. The ratio between the torques evoked by 20 Hz and 80 Hz stimulation declined significantly (P < 0.001; −12%) after exercise. Central activation failure and alterations in excitation–contraction coupling are probable mechanisms contributing to the moderate impairment of the neuromuscular function during prolonged tennis playing.     

Cryotherapy and ankle bracing effects on peroneus longus response during sudden inversion

Cryotherapy and ankle bracing are often used in conjunction as a treatment for ankle injury. No studies have evaluated the combined effect of these treatments on reflex responses during inversion perturbation. This study examined the combined influence of ankle bracing and joint cooling on peroneus longus (PL) muscle response during ankle inversion. A 2 × 2 RM factorial design guided this study; the independent variables were: ankle brace condition (lace-up brace, control), and treatment (ice, control), and the dependent variables studied were PL stretch reflex latency (ms), and PL stretch reflex amplitude (% of max). Twenty-four healthy participants completed 5 trials of a sudden inversion perturbation to the ankle/foot complex under each ankle brace and cryotherapy treatment condition. No two-way interaction was observed between ankle brace and treatment conditions on PL latency (P = 0.283) and amplitude (P = 0.884). The ankle brace condition did not differ from control on PL latency and amplitude. Cooling the ankle joint did not alter PL latency or amplitude compared to the no-ice treatment. Ankle bracing combined with joint cooling does not have a deleterious effect on dynamic ankle joint stabilization during an inversion perturbation in normal subjects.     

Neuromuscular and psychological influences on range of motion recovery in anterior cruciate ligament reconstruction patients

To identify distinguishing characteristics for knee surgery patients who experience a protracted recovery process, we sought to determine if there is an association between the neuromuscular stretch reflex and psychological factors of pain perception and anxiety on the range of motion (ROM) recovery rate of post-operative anterior cruciate ligament reconstruction (ACLR) rehabilitation patients. The ACLR participants were categorized into a slow recovery group (SRG: >6 weeks to recover 0–125° knee flexion [n = 10]) and a normal recovery group (NRG: <6 weeks to recovery 0–125° knee flexion [n = 12]). Control participants (n = 22) were age, gender and activity-level matched to the surgical participants. Neuromuscular testing consisted of sagittal plane video kinematics of the Wartenberg Pendulum Test for determining lower limb stiffness indices and electromyography-monitored patellar tendon tap reflex responses. Psychological and health status assessments consisted of the State–Trait Anxiety Inventory and SF-36? Health Survey. Data revealed that neuromuscular reflex profiles, lower limb stiffness indices, pain, anxiety and SF-36? indices of function were not significantly different between the two surgical groups (SRG and NRG). The surgical groups exhibited significantly greater pain (2.67 ± 2.27 SRG, 1.49 ± 1.15 NRG) than the control group (p ? .05). SF-36? indices were significantly lower for the surgical groups for total score (546.55 ± 94.70 SRG, 577.57 ± 125.58 NRG), function 69.00 ± 20.24 SRG, 67.08 ± 19.12 NRG), role physical (53.75 ± 22.85 SRG, 53.12 ± 23.15 NRG), social (76.24 ± 25.31 SRG, 65.62 ± 27.24 NRG), and emotional (82.49 ± 19.81 SRG, 81.38 ± 23.02 NRG) subscales (p ? .05). These results suggest that neuromuscular reflex responses, visual analogue scale (VAS) pain, and anxiety are not distinguishing factors for ROM recovery rate between the SRG and NRG. Decreased SF-36? indices, including pain as it influences function, though clinically relevant factors, were not statistically associated with post-operative ROM recovery rate.     

Neuromuscular fatigue following low-intensity dynamic exercise with externally applied vascular restriction

This study investigated neuromuscular fatigue following low-intensity resistance exercise with vascular restriction (VR) and without vascular restriction (control, CON). Fourteen males participated in two experimental trials (VR and CON) each separated by 48 h. Each participant performed two isometric maximum voluntary contractions (MVCs) before and after five sets of 20 dynamic constant external resistance leg extension exercises (DCER-EX) at 20% of one-repetition maximum (1-RM). The participants were asked to lift (1.5 s) and lower (1.5 s) the load at a constant velocity. Surface electromyography (EMG) was recorded from the vastus lateralis during MVC and DCER-EX. Twitch interpolation was used to assess the percent of maximal voluntary activation (%VA) during the MVC. During performing five sets of 20 DCER-EX, the increases (p < 0.05) in EMG amplitude and decreases (p < 0.05) in EMG mean power frequency were similar for both VR and CON. However, there were significant differences between VR and CON for MVC force, %VA, and potentiated twitch force and significant interactions for EMG amplitude. VR decreased MVC force, %VA, potentiated twitch force, and EMG amplitude more than CON. Our findings suggest that the VR-induced fatigue may have been due to a combination of peripheral (decreases in potentiated twitch) and central (decreases in %VA and EMG amplitude) fatigue.     

Effect of changes in orientation and position of external loads on trunk muscle activity and kinematics in upright standing

Forces at different heights and orientations are often carried by hands while performing occupational tasks. Trunk muscle activity and spinal loads are likely dependent on not only moments but also the orientation and height of these forces. Here, we measured trunk kinematics and select superficial muscle activity of 12 asymptomatic subjects while supporting forces in hands in upright standing. Magnitude of forces in 5 orientations (−25°, 0°, 25°, 50° and 90°) and 2 heights (20 cm and 40 cm) were adjusted to generate flexion moments of 15, 30 and 45 N m at the L5-S1 disc centre. External forces were of much greater magnitude when applied at lower elevation or oriented upward at 25°. Spinal kinematics remained nearly unchanged in various tasks.Changes in orientation and elevation of external forces substantially influenced the recorded EMG, despite similar trunk posture and identical moments at the L5-S1. Greater EMG activity was overall recorded under larger forces albeit constant moment. Increases in the external moment at the L5-S1 substantially increased EMG in extensor muscles (p < 0.001) but had little effect on abdominals; e.g., mean longissimus EMG for all orientations increased by 38% and 75% as the moment level altered from 15 N m to 30 N m and to 45 N m while that in the rectus abdominus increased only by 2% and 4%, respectively. Under 45 N m moment and as the load orientation altered from 90° to 50°, 25°, 0° and −25°, mean EMG dropped by 3%, 12%, 12% and 1% in back muscles and by 17%, 17%, 19% and 13% in abdominals, respectively. As the load elevation increased from 20 cm to 40 cm, mean EMG under maximum moment decreased by 21% in back muscles and by 17% in abdominals.Due to the lack of EMG recording of deep lumbar muscles, changes in relative shear/compression components and different net moments at cranial discs despite identical moments at the caudal L5-S1 disc, complementary model studies are essential for a better comprehension of neuromuscular strategies in response to alterations in load height and orientation.     

Alternating activation is related to fatigue in lumbar muscles during sustained sitting

The aim of this study was to investigate the relation between variability in muscle activity and fatigue during a sustained low level contraction in the lumbar muscles. Twenty-five healthy participants (13 men 12 women) performed a 30 min sitting task with 5 degrees inclination of the trunk. Surface electromyographic (EMG) signals were recorded bilaterally from the lumbar muscles with 2 high density surface EMG grids of 9 × 14 electrodes. Median frequency (MDF) decrease, amplitude (RMS) increase and the rating of perceived exertion (RPE) were used as fatigue indices. Alternating activation and spatial and temporal variability were computed and relations with the fatigue indices were explored. During sitting, the mono- and bipolar RMS slightly increased while the MDF remained unchanged indicating no systematic muscle fatigue, although the average RPE increased from 6 to 13 on a scale ranging between 6 and 20. Higher frequency of alternating activation between the left and right side was associated with increased RPE (p = 0.03) and decreased MDF (p = 0.05). A tendency in the same direction was seen between increased spatial and temporal variation within the grids and increased RPE and decreased MDF. Present findings provide evidence for a relationship between variability in muscle activity and fatigue.     

Extra-torque of human tibialis anterior during electrical stimulation with linearly varying frequency and amplitude trains

This work aimed to characterise the whole human muscle input/output law during electrical stimulation with triangular varying frequency and amplitude trains through combined analysis of torque, mechanomyogram (MMG) and electromyogram (EMG).The tibialis anterior (TA) of ten subjects (age 23–35 years) was investigated during static contraction obtained through neuromuscular electrical stimulation. After potentiation, TA underwent two 15 s stimulation patterns: (a) frequency triangle (FT): 2 > 35 > 2 Hz at Vmax (amplitude providing full motor unit recruitment); (b) amplitude triangle (AT): Vmin > Vmax > Vmin (Vmin providing TA least mechanical response) at 35 Hz. 2 > 35 Hz or Vmin > Vmax as well as 35 > 2 Hz or Vmax > Vmin were defined as up-going ramp (UGR) and down-going ramp (DGR), respectively. TA torque, MMG and EMG were detected by a load cell, an optical laser distance sensor and a probe with two silver bar electrodes, respectively. For both FT and AT, only the two mechanical signals resulted always larger in DGR than in UGR, during AT extra-torque and extra-MMG were present even in the first 1/3 of the amplitude range where EMG data presented no significant differences between DGR and UGR.Our data suggest that extra-torque and extra-displacement are evident for both FT and AT, being mainly attributed to an intrinsic muscle property.     

Characteristics of human knee muscle coordination during isometric contractions in a standing posture: The effect of limb task

Different functional roles for the hands have been demonstrated, however leg control is not as well understood. The purpose of the present study was to evaluate bilateral knee neuromuscular control to determine if the limb receiving greater attention would have more well-tuned control compared to an unattended limb. Surface electrodes were placed on seven muscles of each limb, before standing on two force platforms. Visual feedback was given of the forces and moments of the “focus limb,” but not the “unattended limb.” Static isometric forces were matched with their focus limb, requiring their unattended limb to push in the opposite direction, using a combination of forward–backward–medial–lateral shear forces while muscle activity was collected bilaterally. There was a significant main effect for limb task (p = 0.02), with the medial hamstrings being more specific (p = 0.001) while performing the unattended limb and the lateral hamstring being more well-tuned (p = 0.007) while performing the focus limb task. The focus limb’s medial and lateral gastrocnemius were principally active in the forwards direction, but only the unattended limb’s lateral gastrocnemius was active in the backwards direction. Findings suggest unique neuromuscular control strategies are used for the legs depending on limb task.     

Effects of repeated ankle plantar-flexions on H-reflex and body sway during standing

The study investigated relations between effects of repeated ankle plantar-flexion movements exercise on the soleus Hoffmann (H) reflex and on postural body sway when maintaining upright stance. Ten young volunteers performed five sets of ankle plantar-flexions of both lower limbs. Assessment of the feet centre-of-pressure (COP) displacement and H-reflex tests were carried out in quiet stance before, during and after the exercise. H-max and M-max responses were obtained in 8 subjects and reported as the peak-to-peak amplitudes of the right soleus muscle electromyographic waves. Mean dispersion of COP along the antero-posterior direction increased significantly during the exercise; whilst the overall H-reflex response indicated a reduction without a concomitant modification in the M-max response. H-reflex responses, however, varied between participants during the first sets of exercise, showing two main trends of modulation: either depression or early facilitation followed by reduction of the H-reflex amplitude. The extent of reflex modulation in standing position was correlated to the concentric work performed during the exercise (r = 0.85; p < 0.01), but not to the antero-posterior COP dispersion. These results suggest that during a repeated ankle plantar-flexions exercise, modulation of the H-reflex measured in upright stance differs across individuals and is not related to changes of postural sway.     

A compensation of angular displacements of the hip joints and lumbosacral spine between subjects with and without idiopathic low back pain during squatting

Low back pain (LBP) is one of the most common symptoms reported in adults. However, the contribution of postural control on the lumbar spine and hips during squatting has not been carefully investigated in individuals with LBP. The aim of this study was to compare three-dimensional kinematic changes of the lumbar spine and hips between subjects with and without idiopathic chronic LBP during squatting activities. In total, 30 subjects enrolled in the study (15 control subjects and 15 subjects with idiopathic chronic LBP). All participants were asked to perform squatting activities five times repeatedly while holding a load of 2 kg in a basket. The outcome measures included the Oswestry Disability Index (ODI) and kinematic angular displacement for the hips and lumbar spine. The LBP group demonstrated increased range of motion (ROM) in flexion of the dominant (T = ?2.14, p = 0.03) and non-dominant (T = ?2.11, p = 0.03) hips during squatting. The lumbar spine flexion ROM significantly decreased (T = 2.20, p = 0.03). The kinematic changes demonstrated interactions with region × group (F = 5.56, p = 0.02), plane × group (F = 4.36, p = 0.04), and region × plane (F = 2292.47, p = 0.001). The ODI level demonstrated significant interaction on combined effects of body region and plane (F = 4.91, p = 0.03). Therefore, the LBP group utilized a compensation strategy to increase hip flexion with a stiffened lumbar spine in the sagittal plane during squatting. This compensatory kinematic strategy could apply to clinical management used to enhance lumbar spine flexibility in subjects with idiopathic chronic LBP.     

A combined passive and active musculoskeletal model study to estimate L4-L5 load sharing

A number of geometrically-detailed passive finite element (FE) models of the lumbar spine have been developed and validated under in vitro loading conditions. These models are devoid of muscles and thus cannot be directly used to simulate in vivo loading conditions acting on the lumbar joint structures or spinal implants. Gravity loads and muscle forces estimated by a trunk musculoskeletal (MS) model under twelve static activities were applied to a passive FE model of the L4-L5 segment to estimate load sharing among the joint structures (disc, ligaments, and facets) under simulated in vivo loading conditions. An equivalent follower (FL), that generates IDP equal to that generated by muscle forces, was computed in each task. Results indicated that under in vivo loading conditions, the passive FE model predicted intradiscal pressures (IDPs) that closely matched those measured under the simulated tasks (R² = 0.98 and root-mean-squared-error, RMSE = 0.18 MPa). The calculated equivalent FL compared well with the resultant force of all muscle forces and gravity loads acting on the L4-L5 segment (R² = 0.99 and RMSE = 58 N). Therefore, as an alternative approach to represent in vivo loading conditions in passive FE model studies, this FL can be estimated by available in-house or commercial MS models. In clinical applications and design of implants, commonly considered in vitro loading conditions on the passive FE models do not adequately represent the in vivo loading conditions under muscle exertions. Therefore, more realistic in vivo loading conditions should instead be used.