A frontal plane model of the lumbar spine subjected to a follower load: implications for the role of muscles

Compression on the lumbar spine is 1000 N for standing and walking and is higher during lifting. Ex vivo experiments show it buckles under a vertical load of 80-100 N. Conversely, the whole lumbar spine can support physiologic compressive loads without large displacements when the load is applied along a follower path that approximates the tangent to the curve of the lumbar spine. This study utilized a two-dimensional beam-column model of the lumbar spine in the frontal plane under gravitational and active muscle loads to address the following question: Can trunk muscle activation cause the path of the internal force resultant to approximate the tangent to the spinal curve and allow the lumbar spine to support compressive loads of physiologic magnitudes? The study identified muscle activation patterns that maintained the lumbar spine model under compressive follower load, resulting in the minimization of internal shear forces and bending moments simultaneously at all lumbar levels. The internal force resultant was compressive, and the lumbar spine model, loaded in compression along the follower load path, supported compressive loads of physiologic magnitudes with minimal change in curvature in the frontal plane. Trunk muscles may coactivate to generate a follower load path and allow the ligamentous lumbar spine to support physiologic compressive loads.     

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.     

An EMG-assisted model calibration technique that does not require MVCs

As personalized biologically-assisted models of the spine have evolved, the normalization of raw electromyographic (EMG) signals has become increasingly important. The traditional method of normalizing myoelectric signals, relative to measured maximum voluntary contractions (MVCs), is susceptible to error and is problematic for evaluating symptomatic low back pain (LBP) patients. Additionally, efforts to circumvent MVCs have not been validated during complex free-dynamic exertions. Therefore, the objective of this study was to develop an MVC-independent biologically-assisted model calibration technique that overcomes the limitations of previous normalization efforts, and to validate this technique over a variety of complex free-dynamic conditions including symmetrical and asymmetrical lifting. The newly developed technique (non-MVC) eliminates the need to collect MVCs by combining gain (maximum strength per unit area) and MVC into a single muscle property (gain ratio) that can be determined during model calibration. Ten subjects (five male, five female) were evaluated to compare gain ratio prediction variability, spinal load predictions, and model fidelity between the new non-MVC and established MVC-based model calibration techniques. The new non-MVC model calibration technique demonstrated at least as low gain ratio prediction variability, similar spinal loads, and similar model fidelity when compared to the MVC-based technique, indicating that it is a valid alternative to traditional MVC-based EMG normalization. Spinal loading for individuals who are unwilling or unable to produce reliable MVCs can now be evaluated. In particular, this technique will be valuable for evaluating symptomatic LBP patients, which may provide significant insight into the underlying nature of the LBP disorder.     

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.     

Prediction of biomechanical parameters in the lumbar spine during static sagittal plane lifting.

A combined approach involving optimization and the finite element technique was used to predict biomechanical parameters in the lumbar spine during static lifting in the sagittal plane. Forces in muscle fascicles of the lumbar region were first predicted using an optimization-based force model including the entire lumbar spine. These muscle forces as well as the distributed upper body weight and the lifted load were then applied to a three-dimensional finite element model of the thoracolumbar spine and rib cage to predict deformation, the intradiskal pressure, strains, stresses, and load transfer paths in the spine. The predicted intradiskal pressures in the L3-4 disk at the most deviated from the in vivo measurements by 8.2 percent for the four lifting cases analyzed. The lumbosacral joint flexed, while the other lumbar joints extended for all of the four lifting cases studied (rotation of a joint is the relative rotation between its two vertebral bodies). High stresses were predicted in the posterolateral regions of the endplates and at the junctions of the pedicles and vertebral bodies. High interlaminar shear stresses were found in the posterolateral regions of the lumbar disks. While the facet joints of the upper two lumbar segments did not transmit any load, the facet joints of the lower two lumbar segments experienced significant loads. The ligaments of all lumbar motion segments except the lumbosacral junction provided only marginal moments. The limitations of the current model and possible improvements are discussed.     

Response of trunk muscle coactivation to changes in spinal stability

The goal of this effort was to assess the neuromuscular response to changes in spinal stability. Biomechanical models suggest that antagonistic co-contraction may be related to stability constraints during lifting exertions. A two-dimensional biomechanical model of spinal equilibrium and stability was developed to predict trunk muscle co-contraction as a function of lifting height and external load. The model predicted antagonistic co-contraction must increase with potential energy of the system even when the external moment was maintained at a constant value. Predicted trends were compared with measured electromyographic (EMG) data recorded during static trunk extension exertions wherein subjects held weighted barbells at specific horizontal and vertical locations relative to the lumbo-sacral spine junction. The task was designed to assure the applied moment was identical during each height condition, thereby changing potential energy without influencing moment. Measured EMG activity in the trunk flexors increased with height of the external load as predicted by the model. Gender difference in spinal stability were also noted. Results empirically demonstrate that the neuromuscular system responds to changes in spinal stability and provide insight into the recruitment of trunk muscle activity.     

Analysis of large compression loads on lumbar spine in flexion and in torsion using a novel wrapping element

Axial compression on the spine could reach large values especially in lifting tasks which also involve large rotations. Experimental and numerical investigations on the spinal multi motion segments in presence of physiological compression loads cannot adequately be carried out due to the structural instability and artefact loads. To circumvent these problems, a novel wrapping cable element is used in a nonlinear finite element model of the lumbosacral spine (L1-S1) to investigate the role of moderate to large compression loads on the lumbar stiffness in flexion and axial moments/rotations. The compression loads up to 2,700 N was applied with no instability or artefact loads. The lumbar stiffness substantially increased under compression force, flexion moment, and axial torque when applied alone. The presence of compression preloads significantly stiffened the load-displacement response under flexion and axial moments/rotations. This stiffening effect was much more pronounced under larger preloads and smaller moments/rotations. Compression preloads also increased intradiscal pressure, facet contact forces, and maximum disc fibre strain at different levels. Forces in posterior ligaments were, however, diminished with compression preload. The significant increase in spinal stiffness, hence, should be considered in biomechanical studies for accurate investigation of the load partitioning, system stability, and fixation systems/disc prostheses.     

Effects of external trunk loads on lumbar spine stability

Stability of the lumbar spine is an important factor in determining spinal response to sudden loading. Using two different methods, this study evaluated how various trunk load magnitudes and directions affect lumbar spine stability. The first method was a quick release procedure in which effective trunk stiffness and stability were calculated from trunk kinematic response to a resisted-force release. The second method combined trunk muscle EMG data with a biomechanical model to calculate lumbar spine stability. Twelve subjects were tested in trunk flexion, extension, and lateral bending under nine permutations of vertical and horizontal trunk loading. The vertical load values were set at 0, 20, and 40% of the subject's body weight (BW). The horizontal loads were 0, 10, and 20% of BW. Effective spine stability as obtained from quick release experimentation increased significantly (p<0.01) with increased vertical and horizontal loading. It ranged from 785 (S.D.=580) Nm/rad under no-load conditions to 2200 (S.D.=1015) Nm/rad when the maximum horizontal and vertical loads were applied to the trunk simultaneously. Stability of the lumbar spine achieved prior to force release and estimated from the biomechanical model explained approximately 50% of variance in the effective spine stability obtained from quick release trials in extension and lateral bending (0.53相似文献   

Validation of an OpenSim full-body model with detailed lumbar spine for estimating lower lumbar spine loads during symmetric and asymmetric lifting tasks

There is currently no validated full-body lifting model publicly available on the OpenSim modelling platform to estimate spinal loads during lifting. In this study, the existing full-body-lumbar-spine model was adapted and validated for lifting motions to produce the lifting full-body model. Back muscle activations predicted by the model closely matched the measured erector spinae activation patterns. Model estimates of intradiscal pressures and in vivo measurements were strongly correlated. The same spine loading trends were observed for model estimates and reported vertebral body implant measurements. These results demonstrate the suitability of this model to evaluate changes in lumbar loading during lifting.     

Predictive equations to estimate spinal loads in symmetric lifting tasks

Response surface methodology is used to establish robust and user-friendly predictive equations that relate responses of a complex detailed trunk finite element biomechanical model to its input variables during sagittal symmetric static lifting activities. Four input variables (thorax flexion angle, lumbar/pelvis ratio, load magnitude, and load position) and four model responses (L4–L5 and L5–S1 disc compression and anterior–posterior shear forces) are considered. Full factorial design of experiments accounting for all combinations of input levels is employed. Quadratic predictive equations for the spinal loads at the L4–S1 disc mid-heights are obtained by regression analysis with adequate goodness-of-fit (R²>98%, p<0.05, and low root-mean-squared-error values compared with the range of predicted spine loads). Results indicate that intradiscal pressure values at the L4–L5 disc estimated based on the predictive equations are in close agreement with available in vivo data measured under similar loadings and postures. Combinations of input (posture and loading) variable levels that yield spine loads beyond the tolerance compression limit of 3400 N are identified using contour plots. Ergonomists and bioengineers, faced with the dilemma of using either complex but more accurate models on one hand or less accurate but simple models on the other hand, have thereby easy-to-use predictive equations that quantifies spinal loads and risk of injury under different occupational tasks of interest.     

Intra-abdominal pressure mechanism for stabilizing the lumbar spine

Currently, intra-abdominal pressure (IAP) is thought to provide stability to the lumbar spine but the exact principles have yet to be specified. A simplified physical model was constructed and theoretical calculations performed to illustrate a possible intra-abdominal pressure mechanism for stabilizing the spine. The model consisted of an inverted pendulum with linear springs representing abdominal and erector spinae muscle groups. The IAP force was simulated with a pneumatic piston activated with compressed air. The critical load of the model was calculated theoretically based on the minimum potential energy principle and obtained experimentally by increasing weight on the model until the point of buckling. Two distinct mechanisms were simulated separately and in combination. One was antagonistic flexor extensor muscle coactivation and the second was abdominal muscle activation along with generation of IAP. Both mechanisms were effective in stabilizing the model of a lumbar spine. The critical load and therefore the stability of the spine model increased with either increased antagonistic muscle coactivation forces or increased IAP along with increased abdominal spring force. Both mechanisms were also effective in providing mechanical stability to the spine model when activated simultaneously. Theoretical calculation of the critical load agreed very well with experimental results (95.5% average error). The IAP mechanism for stabilizing the lumbar spine appears preferable in tasks that demand trunk extensor moment such as lifting or jumping. This mechanism can increase spine stability without the additional coactivation of erector spinae muscles.     

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.     

An EMG-assisted model of loads on the lumbar spine during asymmetric trunk extensions

An EMG-assisted, low-back, lifting model is presented which simulates spinal loading as a function of dynamic, asymmetric, lifting exertions. The purpose of this study has been to develop a model which overcomes the limitations of previous models including static or isokinetic mechanics, inaccurate predictions of muscle coactivity, static interpretation of myoelectric activity, and physiologically unrealistic or variable muscle force per unit area. The present model predicts individual muscle forces from processed EMG data, normalized as a function of trunk angle and asymmetry, and modified to account for muscle length and velocity artifacts. The normalized EMGs are combined with muscle cross-sectional area and intrinsic strength capacity as determined on a per subject basis, to represent tensile force amplitudes. Dynamic internal and external force vectors are employed to predict trunk moments, spinal compression, lateral and anterior shear forces. Data from 20 subjects performing a total of 2160 exertions showed good agreement between predicted and measured values under all trunk angle, asymmetry, velocity, and acceleration conditions. The design represents a significant step toward accurate, fully dynamic modeling of the low-back in multiple dimensions. The benefits of such a model are the insights provided into the effects of motion induced, muscle co-activity on spinal loading in multiple dimensions.     

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.     

Intervertebral reaction force prediction using an enhanced assembly of OpenSim models

OpenSim offers a valuable approach to investigating otherwise difficult to assess yet important biomechanical parameters such as joint reaction forces. Although the range of available models in the public repository is continually increasing, there currently exists no OpenSim model for the computation of intervertebral joint reactions during flexion and lifting tasks. The current work combines and improves elements of existing models to develop an enhanced model of the upper body and lumbar spine. Models of the upper body with extremities, neck and head were combined with an improved version of a lumbar spine from the model repository. Translational motion was enabled for each lumbar vertebrae with six controllable degrees of freedom. Motion segment stiffness was implemented at lumbar levels and mass properties were assigned throughout the model. Moreover, body coordinate frames of the spine were modified to allow straightforward variation of sagittal alignment and to simplify interpretation of results. Evaluation of model predictions for level L1–L2, L3–L4 and L4–L5 in various postures of forward flexion and moderate lifting (8 kg) revealed an agreement within 10% to experimental studies and model-based computational analyses. However, in an extended posture or during lifting of heavier loads (20 kg), computed joint reactions differed substantially from reported in vivo measures using instrumented implants. We conclude that agreement between the model and available experimental data was good in view of limitations of both the model and the validation datasets. The presented model is useful in that it permits computation of realistic lumbar spine joint reaction forces during flexion and moderate lifting tasks. The model and corresponding documentation are now available in the online OpenSim repository.     

Sudden loading during a dynamic lifting task: a simulation study

It is believed that nurses risk the development of back pain as a consequence of sudden loadings during tasks in which they are handling patients. Forward dynamics simulations of sudden loads (applied to the arms) during dynamic lifting tasks were performed on a two-dimensional whole-body model. Loads were in the range of -80 kg to 80 kg, with the initial load being 20 kg. Loading the arm downwards with less than that which equals a mass of 20 kg did not change the compressive forces on the spine when compared to a normal lifting motion with a 20 kg mass in the hands. However when larger loads (40 kg to 80 kg extra in the hands) were simulated, the compressive forces exceeded 13,000 N (above 3400 N is generally considered a risk factor). Loading upwards led to a decrease in the compressive forces but to a larger backwards velocity at the end of the movement. In the present study, it was possible to simulate a fast lifting motion. The results showed that when loading the arms downwards with a force that equals 40 kg or more, the spine was severely compressed. When loading in the opposite direction (unloading), the spine was not compressed more than during a normal lifting motion. In practical terms, this indicates that if a nursing aide tries to catch a patient who is falling, large compressive forces are applied to the spine.     

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.