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

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

A surface electromyography based objective method to identify patients with nonspecific chronic low back pain,presenting a flexion related movement control impairment

Movement control impairments (MCI) are often present in patients with non-specific chronic low back pain (NS-CLBP). Therefore, movement control exercises are widely used to rehabilitate patients. However, the objective assessment remains difficult.The purpose of this study was to develop a statistical model, based on logistic regression analysis, to differentiate patients with NS-CLBP presenting a flexion-related MCI from healthy subjects. This model is based on trunk muscle activation patterns measured by surface electromyography (sEMG), during movement control exercises.Sixty-three healthy male subjects and 36 male patients with a flexion-related MCI participated in this study. Muscle activity of the internal obliques, the external obliques, the lumbar multifidus and the thoracic part of the iliocostalis was registered. Ratios of deep stabilizing to superficial torque producing muscle activity were calculated to examine trunk muscle recruitment patterns during 6 different exercises. Logistic regression analyses were performed (1) to define the ratios and exercises that were most discriminating between patients and non-patients, (2) to make a predictive model. K-Fold cross-validation was used to assess the performance of the predictive model.This study demonstrated that sEMG trunk muscle recruitment patterns during movement control tests, allows differentiating NSCLBP patients with a flexion-related MCI from healthy subjects.     

Distributed moment histogram: A neurophysiology based method of agonist and antagonist trunk muscle activity prediction

A neurocortical-based technique of muscle recruitment is presented to solve the muscle indeterminacy problem for lumbar torso modeling. Cortical recordings from behaving primates have established motor cortex cells that respond to a wide range of task directions, but are tuned to a preferred direction. A characteristic activity pattern of these neurons seems to be associated with effort direction. It was hypothesized that a model which recruits muscles based on a similar distribution would predict antagonistic muscle activity with greater realism than a widely referenced optimization formulation. The predictions of the Distributed Moment Histogram (DMH) method were evaluated under common speed (<30^os⁻¹) sagittal plane lifting conditions using five subjects. The predicted forces showed high correspondence with agonist and antagonist myoelectric patterns. The mean coefficient of determination for the erector spinae was r²=0.91, and 0.41 for the latissimus. For the antagonistic muscles, the rectus abdominus was found to be electrically silent (<3% MVC) and no activity was predicted by the method. The external oblique muscle was observed to be minimally active (<16% MVC), and the DMH method predicted its mostly constant activity with a mean standard error of 1.6% MVC. The realistic antagonistic predictions supported the hypothesis and justify this cortical based technique as an alternative for muscle tension estimation in biomechanical torso modeling. A primary advantage of this method is its computational simplicity and direct physiologic analogy     

Effects of hand and knee positions on muscular activity during trunk extension exercise with the Roman chair

This experimental study was performed to investigate the effects of hand and knee positions on muscular activity during back extension exercises with the Roman chair. Eighteen asymptomatic male amateur athletes performed four prone back extension exercises with two hand positions (crossed-arms and behind-the-head), and two knee positions (extended knee and 90° flexed knee). Surface electromyography (sEMG) was performed to collect data from the lower trapezius (LT), latissimus dorsi (LD), erector spinae in the T12 paraspinal region (ES-T12), erector spinae at the L3 level (ES-L3), gluteus maximus (GM), and biceps femoris (BF). Two-way repeated analysis of variance with two within-subject factors (two hand positions and two knee positions) was used to determine the significance of differences between the exercise conditions, and which hand and knee positions resulted in greater activation with exercise variation. The root mean square sEMG values were normalized using the maximum voluntary isometric contraction (MVIC) and represented as the % of the maximum EMG (%mEMG). There was no significant interaction between knee and hand positions in the %mEMG data. The results showed that the hand position affected the normalized activation of LT; the behind-the-head position resulted in significantly greater muscle activation than the crossed-arms hand position (P < 0.05). The activations of the LD, ES-T10, ES-L4, and GM were greater in the 90° flexed-knee position compared to the extended-knee position (P < 0.05). Although back extension exercise using the Roman chair has been shown to effectively activate the extensor musculature, our results indicated that changing the knee and hand positions could activate specific muscles differently. To achieve greater activation of trunk extensor muscle during extension exercise with the Roman chair, the flexed-knee position is a useful means of increasing resistance.     

Controlling for out-of-plane lumbar moments during unidirectional trunk efforts: Learning and reliability issues related to trunk muscle activation estimates

To assess the electromyographic (EMG) activation of trunk muscle during exertions performed in one primary plane (sagittal, frontal, transverse), we previously proposed a protocol allowing minimizing out-of-plane efforts (coupled moments – CMs) with the use of a static dynamometer combined with a visual feedback system. The aims of this study were to go further by testing motor learning and reliability issues related to such a protocol. Three identical sessions were conducted, where maximal voluntary contractions and submaximal ramp contractions were performed in six different directions while standing in the dynamometer. Two feedback conditions were tested, the simple 1D-feedback in the primary plane and the full 3D-feedback in all planes simultaneously. Surface EMG signals were collected from back and abdominal muscles and EMG amplitude and CMs were computed during the ramp contractions. Providing a 3D feedback to minimize CMs did not improve EMG reliability or in other words, did not reduce the within-subject variability. Providing three assessment days had practically no effect (no learning) on CMs and EMG variables. Overall, the reliability of EMG was at best moderate. However, although this limits its use on an individual basis, it still allows within- and between-group comparisons for research applications.     

Changes in intra-abdominal pressure, trunk muscle activation and force during isokinetic lifting and lowering

Intra-abdominal pressure (IAP), force and electromyographic (EMG) activity from the abdominal (intra-muscular) and trunk extensor (surface) muscles were measured in seven male subjects during maximal and sub-maximal sagittal lifting and lowering with straight arms and legs. An isokinetic dynamometer was used to provide five constant velocities (0.12–0.96 m·s^–1) of lifting (pulling against the resistance of the motor) and lowering (resisting the downward pull of the motor). For the maximal efforts, position-specific lowering force was greater than lifting force at each respective velocity. In contrast, corresponding IAPs during lowering were less than those during lifting. Highest mean force occurred during slow lowering (1547 N at 0.24 m·s^–1) while highest IAP occurred during the fastest lifts (17.8 kPa at 0.48–0.96 m·s^–1). Among the abdominal muscles, the highest level of activity and the best correlation to variations in IAP (r=0.970 over velocities) was demonstrated by the transversus abdominis muscle. At each velocity the EMG activity of the primary trunk and hip extensors was less during lowering (eccentric muscle action) than lifting (concentric muscle action) despite higher levels of force (r between –0.896 and –0.851). Sub-maximal efforts resulted in IAP increasing linearly with increasing lifting or lowering force (r=0.918 and 0.882, respectively). However, at any given force IAP was less during lowering than lifting. This difference was negated if force and IAP were expressed relative to their respective lifting and lowering maxima. It appears that the IAP increase primarily accomplished by the activation of the transversus abdominis muscle can have the dual function of stabilising the trunk and reducing compression forces in the lumbar spine via its extensor moment. The neural mechanisms involved in sensing and regulating both IAP and trunk extensor activity in relation to the type of muscle action, velocity and effort during the maximal and sub-maximal loading tasks are unknown.     

The effects of normalization method on antagonistic activity patterns during eccentric and concentric isokinetic knee extension and flexion

The purpose of this study was to compare different normalization methods of electromyographic (EMG) activity of antagonists during isokinetic eccentric and concentric knee movements. Twelve women performed three maximum knee extensions and flexions isometrically and at isokinetic concentric and eccentric angular velocities of 30 °·s⁻¹, 90 °·s⁻¹, 120 °·s⁻¹ and 150 °·s⁻¹. The EMG activity of the vastus lateralis, rectus femoris, vastus medialis and hamstrings was recorded. The antagonist integrated IEMG values were normalized relative to the EMG of the same muscle during an isometric maximal action (static method). The values were also expressed as a percentage of the EMG activity of the same muscle, at the same angle, angular velocity and muscle action (dynamic method) when the muscle was acting as an agonist. Three-way analysis of variance (ANOVA) designs indicated significantly greater IEMG normalized with the dynamic method compared to the EMG derived using the static method (P < 0.05). These differences were more evident at concentric angular velocities and at the first and last 20 ° of the movement. The present findings demonstrate that the method of normalization significantly influences the conclusions on antagonistic activity during isokinetic maximum voluntary efforts. The dynamic method of normalization is more appropriate because it considers the effects of muscle action, muscle length and angular velocity on antagonist IEMG.     

Abdominal and hip flexor muscle activation during various training exercises

 The purpose of this study was to provide objective information on the involvement of different abdominal and hip flexor muscles during various types of common training exercises used in rehabilitation and sport. Six healthy male subjects performed altogether 38 different static and dynamic training exercises – trunk and hip flexion sit-ups, with various combinations of leg position and support, and bi- and unilateral leg lifts. Myoelectric activity was recorded with surface electrodes from the rectus abdominis, obliquus externus, obliquus internus, rectus femoris, and sartorius muscles and with indwelling fine-wire electrodes from the iliacus muscle. The mean electromyogram amplitude, normalised to the highest observed value, was compared between static and dynamic exercises separately. The hip flexors were highly activated only in exercises involving hip flexion, either lifting the whole upper body or the legs. In contrast, the abdominal muscles showed marked activation both during trunk and hip flexion sit-ups. In hip flexion sit-ups, flexed and supported legs increased hip flexor activation, whereas such modifications did not generally alter the activation level of the abdominals. Bilateral, but not unilateral, leg lifts required activation of abdominal muscles. In trunk flexion sit-ups an increased activation of the abdominal muscles was observed with increased flexion angle, whereas the opposite was true for hip flexion sit-ups. Bilateral leg lifts resulted in higher activity levels than hip flexion sit-ups for the iliacus and sartorius muscles, while the opposite was true for rectus femoris muscles. These data could serve as a basis for improving the design and specificity of test and training exercises. Accepted: 12 August 1996     

An electromyographical comparison of trunk muscle activity during isometric trunk and dynamic strengthening exercises

The purpose of this study was to compare rectus abdominis and erector spinae muscle activity during isometric (prone bridge [PB] and superman [SM]) and dynamic strengthening exercises (back squat, front squat [FS], and military press). Participants (n = 10, age 21.8 ± 2.6 years; body mass 82.65 ± 10.80 kg, 174.5± 7.2 cm), performed each exercise in a randomized order, using a repeated-measures design. Electromyographical (EMG) activity (sampling at 2,000 Hz) of the rectus abdominis (RA) and the erector spinae (ES) muscles was recorded throughout the duration of the exercises. Intraclass correlations demonstrated the highest levels of reliability for muscle activity during the isometric exercises; however, all exercises demonstrated high level of reliability (r = 0.764-0.998, p ≤ 0.01). The PB demonstrated significantly greater (p < 0.01) RA activity compared to all other exercises. The ES activity was significantly (p < 0.01) greater during the FS (1.010 ± 0.308 root mean square value [RMS (V)]) and SM (0.951 ± 0.217 RMS[V]) and compared to all other exercises, although there was no significant difference (p > 0.05) between the FS and the SM exercise. The PB may be the most suitable exercise for strengthening the RA, compared to dynamic exercises at a low to moderate load, because of a higher level of muscle activity. The FS may be a useful alternative to isometric exercises when strengthening the ES, because it results in slightly higher muscle activity levels when using only a light to moderate load. Because of the dynamic nature of the FS, this may also be more beneficial in transferring to activities of daily living and sporting environments.     

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.     

Effects of mechanical assistance on muscle activity and motor performance during isometric elbow flexion

Mechanical assistance on joint movement is generally beneficial; however, its effects on cooperative performance and muscle activity needs to be further explored. This study examined how motor performance and muscle activity are altered when mechanical assistance is provided during isometric force control of ramp-down and hold phases. Thirteen right-handed participants (age: 24.7 ± 1.8 years) performed trajectory tracking tasks. Participants were asked to maintain the reference magnitude of 47 N (REF) during isometric elbow flexion. The force was released to a step-down magnitude of either 75% REF or 50% REF and maintained, with and without mechanical assistance. The ramp-down durations of force release were set to 0.5, 2.5, or 5.0 s. Throughout the experiment, we measured the following: (1) the force output using load cells to compute force variability and overshoot ratio; (2) peak perturbation on the elbow movement using an accelerometer; (3) the surface electromyography (sEMG) from biceps brachii and triceps brachii muscles; and (4) EMG oscillation from the biceps brachii muscle in the bandwidth of 15–45 Hz. Our results indicated that mechanical assistance, which involved greater peak perturbation, demonstrated lower force variability than non-assistance (p < 0.01), while EMG oscillation in the biceps brachii muscle from 15 to 45 Hz was increased (p < 0.05). These findings imply that if assistive force is provided during isometric force control, the central nervous system actively tries to stabilize motor performance by controlling specific motor unit activity in the agonist muscle.     

Test–retest reliability of cardinal plane isokinetic hip torque and EMG

The objective of the present study was to establish test–retest reliability of isokinetic hip torque and prime mover electromyogram (EMG) through the three cardinal planes of motion. Thirteen healthy young adults participated in two experimental sessions, separated by approximately one week. During each session, isokinetic hip torque was evaluated on the Biodex Isokinetic Dynamometer at a velocity of 60 deg/s. Subjects performed three maximal-effort concentric and eccentric contractions, separately, for right and left hip abduction/adduction, flexion/extension, and internal/external rotation. Surface EMGs were sampled from the gluteus maximus, gluteus medius, adductor, medial and lateral hamstring, and rectus femoris muscles during all contractions. Intraclass correlation coefficients (ICC – 2,1) and standard errors of measurement (SEM) were calculated for peak torque for each movement direction and contraction mode, while ICCs were only computed for the EMG data. Motions that demonstrated high torque reliability included concentric hip abduction (right and left), flexion (right and left), extension (right) and internal rotation (right and left), and eccentric hip abduction (left), adduction (left), flexion (right), and extension (right and left) (ICC range = 0.81–0.91). Motions with moderate torque reliability included concentric hip adduction (right), extension (left), internal rotation (left), and external rotation (right), and eccentric hip abduction and adduction (right), flexion (left), internal rotation (right and left), and external rotation (right and left) (ICC range = 0.49–0.79). The majority of the EMG sampled muscles (n = 12 and n = 11 for concentric and eccentric contractions, respectively) demonstrated high reliability (ICC = 0.81–0.95). Instances of low, or unacceptable, EMG reliability values occurred for the medial hamstring muscle of the left leg (both contraction modes) and the adductor muscle of the right leg during eccentric internal rotation. The major finding revealed high and moderate levels of between-day reliability of isokinetic hip peak torque and prime mover EMG. It is recommended that the day-to-day variability estimates concomitant with acceptable levels of reliability be considered when attempting to objectify intervention effects on hip muscle performance.     

The effect of lower-limb prosthetic alignment on muscle activity during sit-to-stand

People with a transtibial amputation (TTA) have altered motion during daily tasks, which may be influenced by prosthetic alignment. This study aimed to determine the effect of medial/lateral prosthetic alignment shifts on muscle activity, measured by integrated electromyography (iEMG), and to compare muscle activity between people with and without TTA during sit-to-stand. We quantified ground reaction forces and three-dimensional center-of-mass position to interpret muscle activity results. Compared to the prescribed alignment, the bilateral knee extensors had greater activity in the medial alignment (p < 0.001) and the amputated side gluteus medius and less activity in the lateral alignment (p = 0.035), which may be a result of altered muscular requirements for postural control. In people with TTA, smaller intact side gluteus medius activity was associated with frontal plane motion of the center-of-mass, which was not observed in non-amputees. Compared to non-amputees, people with TTA had greater iEMG in the intact side tibialis anterior (p = 0.031) and amputated side rectus femoris (p < 0.001), which may be required to brake the body center-of-mass in the absence of amputated side tibialis anterior. These results suggest that lateral alignment shifts may reduce muscle activity during sit-to-stand for people with TTA and emphasize the importance of analyzing sit-to-stand in three dimensions.     

The use of intermittent trunk flexion to alleviate low back pain during prolonged standing

The current study examined of the effect of intermittent, short-term periods of full trunk flexion on the development of low back pain (LBP) during two hours of standing. Sixteen participants completed two 2-h standing protocols, separated by one week. On one day, participants stood statically for 2 h (control day); on the other day participants bent forward to full spine flexion (termed flexion trials) to elicit the flexion relaxation (FR) phenomenon for 5 s every 15 min (experimental day). The order of the control and experimental day was randomized. During both protocols, participants reported LBP using a 100 mm visual analogue scale every 15 min. During the flexion trials, lumbar spine posture, erector spinae and gluteus medius muscle activation was monitored. Ultimately, intermittent trunk flexion reduced LBP by 36% (10 mm) at the end of a 2-h period of standing. Further, erector spinae and gluteus medius muscle quietening during FR was observed in 91% and 65% of the flexion trials respectively, indicating that periods of rest did occurred possibly contributing to the reduction in LBP observed. Since flexion periods do not require any aids, they can be performed in most workplaces thereby increasing applicability.     

sEMG activity of masticatory, neck, and trunk muscles during the treatment of scoliosis with functional braces. A longitudinal controlled study

Background

Studies on the relationship between occlusal problems and the spine are of increasing interest. In this study, we monitored the sEMG activity of masticatory, neck, and trunk muscles during the treatment of scoliosis in young patients, and compared the data with a control of untreated group.

Subjects and methods

Twelve white Caucasian patients (nine males and three females; mean age of 8.0 ± 1.5 years) with scoliosis and Class I occlusion (without crowding) were included in this study (study group). Fifteen healthy subjects (nine males and six females; mean age of 9.5 ± 0.8 years) were recruited as control group. The subjects were visited before they underwent the treatment of scoliosis, as well as after 3 (T1) and 6 months (T2) of their treatment for scoliosis. The patients were instructed to wear the device during sleep and during the day, according to the protocol given by their orthopedic.

Results

The treated group showed statistically significant changes in the sEMG activity of masticatory, neck, and trunk muscles, both at rest and during MVC of the mandible with respect to T0. The masseter and the anterior temporalis showed a significant improvement in the asymmetry index from T0 to T2. On the other hand, subjects in the control group did not register much change.

Conclusion

Our findings suggest that the use of a functional device for the treatment of scoliosis induces a significant reduction in the asymmetry index of the trunk muscles, as well as a significant increase in the contractility of masticatory muscles.     

Shear modulus of multifidus and longissimus muscles measured using shear wave elastography correlates with muscle activity,but depends on image quality

Shear wave elastography (SWE) estimates shear modulus in muscle. This is interpreted as an index of muscle stiffness, but depends on muscle characteristics. This study evaluated relationship between shear modulus and myoelectric activity of lumbar multifidus and longissimus muscles to assess its validity. Intramuscular electromyography (EMG) of multifidus (deep [DM], superficial [SM] fibres) at L4/5, longissimus [LG] at L2, were recorded in nine healthy participants. Participants performed isometric trunk extension in side-lying from 0 to 30% maximal voluntary contraction (MVC) with EMG amplitude feedback. Using SWE, two regions of interest (ROI) were investigated in each muscle. Generally, shear modulus was moderately correlated with root mean squared (RMS) EMG (r = 0.50–0.78). Univariate and multiple regression analyses showed ultrasound/SWE features of ‘B-mode quality’ (24.5%), ‘%Void pixels’ (17.9%) and ‘Connective tissue’ (16.2%) explained most variation in the shear modulus/EMG relationship. Regression prediction scores generated using imaging features were correlated with r-coefficients of shear modulus/EMG relationship. When analysis was restricted to high quality data (i.e., regression prediction score above an a priori defined threshold), the shear modulus/EMG relationship increased to r = 0.70–0.96. Although a linear relationship between shear modulus/EMG was confirmed, supporting validity of SWE measures in anatomically distinct back muscles, this depends on image quality.     

Scapular muscle activity in a variety of plyometric exercises

Background: Plyometric shoulder exercises are commonly used to progress from slow analytical strength training to more demanding high speed power training in the return to play phase after shoulder injury. The aim of this study was first, to investigate scapular muscle activity in plyometric exercises to support exercise selection in practice and second, to enhance understanding of how scapular muscles are recruited during the back and forth movement phase of these exercises. Methods: Thirty-two healthy subjects performed 10 plyometric exercises while surface EMG-activity of the scapular muscles (upper (UT), middle (MT) and lower trapezius (LT) and serratus anterior (SA)) was registered. A high speed camera tracked start and end of the back and forth movement. Results: Mean scapular EMG activity during the 10 exercises ranged from 14.50% to 76.26%MVC for UT, from 15.19% to 96.55%MVC for MT, from 13.18% to 94.35%MVC for LT and from 13.50% to 98.50%MVC for SA. Anova for repeated measures showed significant differences in scapular muscle activity between exercises (p < 0.001) and between the back and forth movement (p < 0.001) within exercises. Conclusion: Plyometric shoulder exercises require moderate (31–60%MVC) to high (>60%MVC) scapular muscle activity. Highest MT/LT activity was present in prone plyometric external rotation and flexion. Highest SA activity was found in plyometric external rotation and flexion with Xco and plyometric push up on Bosu. Specific exercises can be selected that recruit minimal levels of UT activity (<15%): side lying plyometric external rotation and horizontal abduction or plyometric push up on the Bosu. The results of this study support exercise selection for clinical practice.     

Interrelated hypoalgesia,creep, and muscle fatigue following a repetitive trunk flexion exposure

Repetitive trunk flexion can damage spinal tissues, however its association with low back pain in the workplace may be confounded by factors related to pain sensitivity. Muscle fatigue, exercise-induced hypoalgesia, and creep-induced neuromuscular changes following repetitive trunk flexion may all affect this assumed exposure-pain relationship. This study’s purpose was to determine how mechanical pain sensitivity in the low back is affected by a repetitive trunk flexion exposure and identify factors associated with changes in low back pain sensitivity. Pressure pain thresholds, perceptions of sub-threshold stimuli, and muscle fatigue in the trunk and tibia, as well as lumbar spine creep were tracked in 37 young healthy adults before and up to 40 min after a 10-min repetitive trunk flexion exposure. Pressure pain thresholds (p = 0.033), but not perceptions of sub-threshold stimuli (p > 0.102) were associated with approximately a 12.5% reduction in pain sensitivity 10 min after completing the exposure, while creep and local muscle fatigue effects were only observed immediately following the exposure. Creep and fatigue interactions and the corresponding tibial measure co-varied with individual low back pressure pain thresholds. The net hypoalgesic effects of repetitive trunk flexion have the potential to partially mask possibly injurious loads, which could contribute to the severity or incidence of lower back injuries related to these exposures.     

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

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

The effect of tactile and verbal guidance during scapulothoracic exercises: An EMG and kinematic investigation

BackgroundClinician-led training through tactile and verbal guidance to improve muscle activity and joint motion are a common but understudied focus of therapeutic interventions for shoulder pain. The purpose of this study was to determine if clinician guidance changes scapulothoracic muscle activity and kinematics compared to unguided shoulder exercises.MethodsEleven participants with shoulder pain were studied. Electromyographic (EMG) sensors were placed on the serratus anterior and upper and lower trapezii. Scapulothoracic and sternoclavicular kinematics were collected using electromagnetic sensors. Five common resisted shoulder exercises were performed with the following guidance: unguided, combined (verbal and tactile cues), and verbal guidance only. One-way repeated measures ANOVAs determined the effect of guidance versus unguided conditions for each exercise.ResultsNine of ten combinations of exercise and guidance techniques demonstrated a significant effect of guidance for either muscle activity or joint kinematics. The guidance condition with the most frequent significant improvements across all variables was the combined condition. The exercises with the most frequent significant improvements across all variables were the external rotation exercises. Variables improved most frequently were: upper:lower trapezius EMG ratio (up to 11%), sternoclavicular elevation (up to 6°) and scapulothoracic internal rotation positioning (up to 8°), and sternoclavicular retraction displacement (up to 5°).ConclusionShoulder muscle activity and kinematics during exercises can be modified by tactile and verbal guidance. Most improvements in muscle activity occurred with verbal guidance during external rotation exercises. Most improvements in joint positioning and movement occurred with combined guidance during external rotation exercises.