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   

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

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

The effect of resistance level and stability demands on recruitment patterns and internal loading of spine in dynamic flexion and extension using a simple trunk model

The effects of external resistance on the recruitment of trunk muscles in sagittal movements and the coactivation mechanism to maintain spinal stability were investigated using a simple computational model of iso-resistive spine sagittal movements. Neural excitation of muscles was attained based on inverse dynamics approach along with a stability-based optimisation. The trunk flexion and extension movements between 60° flexion and the upright posture against various resistance levels were simulated. Incorporation of the stability constraint in the optimisation algorithm required higher antagonistic activities for all resistance levels mostly close to the upright position. Extension movements showed higher coactivation with higher resistance, whereas flexion movements demonstrated lower coactivation indicating a greater stability demand in backward extension movements against higher resistance at the neighbourhood of the upright posture. Optimal extension profiles based on minimum jerk, work and power had distinct kinematics profiles which led to recruitment patterns with different timing and amplitude of activation.     

The effect of resistance level and stability demands on recruitment patterns and internal loading of spine in dynamic flexion and extension using a simple trunk model

The effects of external resistance on the recruitment of trunk muscles in sagittal movements and the coactivation mechanism to maintain spinal stability were investigated using a simple computational model of iso-resistive spine sagittal movements. Neural excitation of muscles was attained based on inverse dynamics approach along with a stability-based optimisation. The trunk flexion and extension movements between 60° flexion and the upright posture against various resistance levels were simulated. Incorporation of the stability constraint in the optimisation algorithm required higher antagonistic activities for all resistance levels mostly close to the upright position. Extension movements showed higher coactivation with higher resistance, whereas flexion movements demonstrated lower coactivation indicating a greater stability demand in backward extension movements against higher resistance at the neighbourhood of the upright posture. Optimal extension profiles based on minimum jerk, work and power had distinct kinematics profiles which led to recruitment patterns with different timing and amplitude of activation.     

Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain

People with a history of low back pain (LBP) are at high risk to encounter additional LBP episodes. During LBP remission, altered trunk muscle control has been suggested to negatively impact spinal health. As sudden LBP onset is commonly reported during trunk flexion, the aim of the current study is to investigate whether dynamic trunk muscle recruitment is altered in LBP remission. Eleven people in remission of recurrent LBP and 14 pain free controls performed cued trunk flexion during a loaded and unloaded condition. Electromyographic activity was recorded from paraspinal (lumbar and thoracic erector spinae, latissimus dorsi, deep and superficial multifidus) and abdominal muscles (obliquus internus, externus and rectus abdominis) with surface and fine-wire electrodes. LBP participants exhibited higher levels of co-contraction of flexor/extensor muscles, lower agonistic abdominal and higher antagonistic paraspinal muscle activity than controls, both when data were analyzed in grouped and individual muscle behavior. A sub-analysis in people with unilateral LBP (n = 6) pointed to opposing changes in deep and superficial multifidus in relation to the pain side. These results suggest that dynamic trunk muscle control is modified during LBP remission, and might possibly increase spinal load and result in earlier muscle fatigue due to intensified muscle usage. These negative consequences for spinal health could possibly contribute to recurrence of LBP.     

Evidence for a role of antagonistic cocontraction in controlling trunk stiffness during lifting

Activity of the abdominal muscles during symmetric lifting has been a consistent finding in many studies. It has been hypothesized that this antagonistic coactivation increases trunk stiffness to provide stability to the spine. To test this, we investigated whether abdominal activity in lifting is increased in response to destabilizing conditions.

Ten healthy male subjects lifted 35 l containers containing 15 l of water (unstable condition), or ice (stable condition). 3D-kinematics, ground reaction forces, and EMG of selected trunk muscles were recorded. Euler angles of the thorax relative to the pelvis were determined. Inverse dynamics was used to calculate moments about L5S1. Averaged normalized abdominal EMG activity was calculated to express coactivation and an EMG-driven trunk muscle model was used to estimate the flexor moment produced by these muscles and to estimate the L5S1 compression force.

Abdominal coactivation was significantly higher when lifting the unstable load. This coincided with significant increases in estimated moments produced by the antagonist muscles and in estimated compression forces on the L5S1 disc, except at the instant of the peak moment about L5S1. The lifting style was not affected by load instability as evidenced by the absence of effects on moments about L5S1 and angles of the thorax relative to the pelvis. The data support the interpretation of abdominal cocontraction during lifting as subserving spinal stability. An alternative function of the increased trunk stiffness due to cocontraction might be to achieve more precise control over the trajectory of lifted weight in order to avoid sloshing of the water mass in the box and the consequent perturbations.     

Motor unit activation patterns during concentric wrist flexion in humans with different muscle fibre composition

Muscle activity was recorded from the flexor carpi radialis muscle during static and dynamic-concentric wrist flexion in six subjects, who had exhibited large differences in histochemically identified muscle fibre composition. Motor unit recruitment patterns were identified by sampling 310 motor units and counting firing rates in pulses per second (pps). During concentric wrist flexion at 30% of maximal exercise intensity the mean firing rate was 27 (SD 13) pps. This was around twice the value of 12 (SD 5) pps recorded during sustained static contraction at 30% of maximal voluntary contraction, despite a larger absolute force level during the static contraction. A similar pattern of higher firing rates during dynamic exercise was seen when concentric wrist flexion at 60% of maximal exercise intensity [30 (SD 14) pps] was compared with sustained static contraction at 60% of maximal voluntary contraction [19 (SD 8) pps]. The increase in dynamic exercise intensity was accomplished by recruitment of additional motor units rather than by increasing the firing rate as during static contractions. No difference in mean firing rates was found among subjects with different muscle fibre composition, who had previously exhibited marked differences in metabolic response during corresponding dynamic contractions. It was concluded that during submaximal dynamic contractions motor unit firing rate cannot be deduced from observations during static contractions and that muscle fibre composition may play a minor role. Accepted: 5 May 1998     

Paraspinal muscle vibration alters dynamic motion of the trunk

Loss in dynamic stability of the low back has been identified as a potential factor in the etiology of low back injuries. A number of factors are important in the ability of a person to maintain an upright trunk posture including the preparatory stiffness of the trunk and the magnitude and timing of the neuromotor response. A neuromotor response requires appropriate sensing of joint motion. In this research, the role of this sensory ability in dynamic performance of the trunk was examined using a simple pendulum model of the trunk with neuromotor feedback. An increased sensory threshold was found to lead to increased torso flexion and increased delay in neuromotor response. This was confirmed experimentally using paraspinal muscle vibration which is known to alter proprioception of the muscle spindle organs. Before, during and after exposure to bilateral, paraspinal muscle vibration for 20 minutes, the dynamic response of subjects to an unexpected torso flexion load was examined. Subjects were found to have a 19.5% slower time to peak muscle activity and a 16.1% greater torso flexion during exposure to paraspinal muscle vibration. Torso flexion remained significantly increased after vibration exposure relative to before exposure. These results suggest that the neuromotor response plays an important role in trunk dynamics. Loss in sensitivity of the sensory system can have a detrimental effect on trunk dynamics, increasing delays in neuromotor response and increasing the motion of the trunk in response to an unexpected load.     

Is the trunk movement more perturbed after an asymmetric than after a symmetric perturbation during lifting?

Low back injury is associated with sudden movements and loading. Trunk motion after sudden loading depends on the stability of the spine prior to loading and on the trunk muscle activity in response to the loading. Both factors are not axis-symmetric. Therefore, it was hypothesized that the effects on trunk dynamics would be larger after an asymmetric than after a symmetric perturbation. Ten subjects lifted a crate in which, prior to lifting, a mass was displaced to the front or to the side without the subjects being aware of this. Crate and subject movements, crate reaction forces and muscle activity were recorded. From this, the stability prior to the perturbation was estimated, and the trunk angular kinematics and moments at the lumbo-sacral joint were calculated. Both perturbations only minimally affected the trunk kinematics, although the stability of the spine prior to the lifting movement was higher in the sagittal plane than in the frontal plane. In both conditions the stability appeared to be sufficient to absorb the applied perturbation.     

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.     

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     

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.     

Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension

Prone hip extension has been used as a self-perturbation task to test the stability of the lumbopelvic region. However, the relationship between recruitment patterns in the hip and trunk muscles and lumbopelvic kinematics remains unknown. The present study aimed to examine if the balance of hip and trunk muscle activities are related to pelvic motion and low back muscle activity during prone hip extension. Sixteen healthy participants performed prone hip extension from 30° of hip flexion to 10° of hip extension. Surface electromyography (of the gluteus maximus, semitendinosus, rectus femoris, tensor fasciae latae, multifidus, and erector spinae) and pelvic kinematic measurements were collected. Results showed that increased activity of the hip flexor (tensor fasciae latae) relative to that of hip extensors (gluteus maximus and semitendinosus) was significantly associated with increased anterior pelvic tilt during hip extension (r=0.52). Increased anterior pelvic tilt was also significantly related to the delayed onset timing of the contralateral and ipsilateral multifidus (r=0.57, r=0.53) and contralateral erector spinae (r=0.63). Additionally, the decrease of the gluteus maximus activity relative to the semitendinosus was significantly related to increased muscle activity of the ipsilateral erector spinae (r=-0.57). These results indicate that imbalance between the agonist and antagonist hip muscles and delayed trunk muscle onset would increase motion in the lumbopelvic region.     

Learning to walk with a robotic ankle exoskeleton

We used a lower limb robotic exoskeleton controlled by the wearer's muscle activity to study human locomotor adaptation to disrupted muscular coordination. Ten healthy subjects walked while wearing a pneumatically powered ankle exoskeleton on one limb that effectively increased plantar flexor strength of the soleus muscle. Soleus electromyography amplitude controlled plantar flexion assistance from the exoskeleton in real time. We hypothesized that subjects' gait kinematics would be initially distorted by the added exoskeleton power, but that subjects would reduce soleus muscle recruitment with practice to return to gait kinematics more similar to normal. We also examined the ability of subjects to recall their adapted motor pattern for exoskeleton walking by testing subjects on two separate sessions, 3 days apart. The mechanical power added by the exoskeleton greatly perturbed ankle joint movements at first, causing subjects to walk with significantly increased plantar flexion during stance. With practice, subjects reduced soleus recruitment by approximately 35% and learned to use the exoskeleton to perform almost exclusively positive work about the ankle. Subjects demonstrated the ability to retain the adapted locomotor pattern between testing sessions as evidenced by similar muscle activity, kinematic and kinetic patterns between the end of the first test day and the beginning of the second. These results demonstrate that robotic exoskeletons controlled by muscle activity could be useful tools for testing neural mechanisms of human locomotor adaptation.     

Constraining spine stability levels in an optimization model leads to the prediction of trunk muscle cocontraction and improved spine compression force estimates

A major limitation of optimization models of the spine has been the inability to accurately predict trunk muscle co-activity. Antagonist muscle activity is thought to be necessary to maintain adequate levels of spine stability but, in turn, creates increased loading on the spine. It is thus hypothesized that the CNS attempts to optimize the relationship between spine loading and spine stability in determining muscular activation patterns. This study presents an optimization model of the spine in which stability was constrained to target levels predicted from regression equations of independent loading variables. Objective functions were set to either minimize the sum of the cubed muscle forces or minimize the sum of the squared intervertebral forces at the L4-L5 disc level. Results demonstrate that the inclusion of stability constraints in optimization simulations produced realistic predictions of antagonist muscle activity and predictions of spine compression levels that agree more closely with EMG-based estimates, compared to simulations in which stability was unconstrained. It was concluded that spinal stability is a vital consideration for the CNS when dictating trunk muscle recruitment patterns.     

Links between the mechanics of ventilation and spine stability

Spine stability is ensured through isometric coactivation of the torso muscles; however, these same muscles are used cyclically to assist ventilation. Our objective was to investigate this apparent paradoxical role (isometric contraction for stability or rhythmic contraction for ventilation) of some selected torso muscles that are involved in both ventilation and support of the spine. Eight, asymptomatic, male subjects provided data on low back moments, motion, muscle activation, and hand force. These data were input to an anatomically detailed, biologically driven model from which spine load and a lumbar spine stability index was obtained. Results revealed that subjects entrained their torso stabilization muscles to breathe during demanding ventilation tasks. Increases in lung volume and back extensor muscle activation coincided with increases in spine stability, whereas declines in spine stability were observed during periods of low lung inflation volume and simultaneously low levels of torso muscle activation. As a case study, aberrant ventilation motor patterns (poor muscle entrainment), seen in one subject, compromised spine stability. Those interested in rehabilitation of patients with lung compromise and concomitant back troubles would be assisted with knowledge of the mechanical links between ventilation during tasks that impose spine loading.     

Trunk response to sudden forward perturbations – Effects of preload and sudden load magnitudes,posture and abdominal antagonistic activation

Unexpected loading of the spine is a risk factor for low back pain. The trunk neuromuscular and kinematics responses are likely influenced by the perturbation itself as well as initial trunk conditions. The effect of four parameters (preload, sudden load, initial trunk flexed posture, initial abdominal antagonistic activity) on trunk kinematics and back muscles reflex response were evaluated. Twelve asymptomatic subjects participated in sudden forward perturbation tests under six distinct conditions. Preload did not change the reflexive response of back muscles and the trunk displacement; while peak trunk velocity and acceleration as well as the relative load peak decreased. Sudden load increased reflex response of muscles, trunk kinematics and loading variables. When the trunk was initially flexed, back muscles latency was delayed, trunk velocity and acceleration increased; however, reflex amplitude and relative trunk displacement remained unchanged. Abdominal antagonistic preactivation increased reflexive response of muscles but kinematics variables were not affected. Preload, initial flexed posture and abdominal muscles preactivation increased back muscles preactivity. Both velocity and acceleration peaks of the trunk movement decreased with preload despite greater total load. In contrast, they increased in the initial flexed posture and to some extent when abdominal muscles were preactivated demonstrating the distinct effects of pre-perturbation variables on trunk kinematics and risk of injury.     

Strategies used to stabilize the elbow joint challenged by inverted pendulum loading

The stiffness of activated muscles may stabilize a loaded joint by preventing perturbations from causing large displacements and injuring the joint. Here the elbow muscle recruitment patterns were compared with the forearm loaded vertically (a potentially unstable inverted pendulum configuration) and with horizontal loading. Eighteen healthy subjects were studied with the forearm vertical and supinated and the elbow flexed approximately 90 degrees. In the first experiment EMG electrodes recorded activity of biceps, triceps, and brachioradialis muscles for joint torques produced (a) by voluntarily exerting a horizontal force isometrically (b) by voluntarily flexing and extending the elbow while the forearm was loaded vertically with 135N. The relationship between the EMG and the torque generated was quantified by the linear regression slope and zero-torque intercept. In a second experiment a vertical load increasing linearly with time up to 300N was applied.In experiment 1 the EMG-torque relationships for biceps and triceps had an intercept about 10% of maximum voluntary effort greater with the vertical compared to the horizontal force, the inverse was found for Brachioradialis, but the EMG-torque slopes for both agonist and antagonistic muscles were not different. In experiment 2 there were 29 trials with minimal elbow displacement and all the three muscles activated on the order of 11% of maximum activation to stabilize the elbow; 19 trials had small elbow extension and 14 trials small flexion requiring altered muscle forces for equilibrium; 7 trials ended in large unstable displacement or early termination of the test. An analysis indicate that the observed levels of muscle activation would only provide stability if the muscles' short-range stiffness was at the high end of the published range, hence the elbow was marginally stable. The stability analysis also indicated that the small elbow extension increased stability and flexion decreased stability.     

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

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

Effects of trunk muscle fatigue and load timing on spinal responses during sudden hand loading

The purpose of this study was to investigate the responses of the spine during sudden loading in the presence of back and abdominal muscle fatigue, with a primary focus on the implications for spinal stability. Fifteen females were studied and each received sudden loads to the hands, at both known and unknown times. Participants received these loading trials (a) while rested, (b) with back muscle fatigue, and (c) with a combination of back and abdominal muscle fatigue. Measures were taken on the EMG activity of two trunk extensor and two abdominal muscles, and on the trunk angle and centre of pressure. A 3 × 2 Repeated Measures ANOVA was also performed. There were no preparations made prior to the perturbation even when it could be anticipated. However, the peak responses that followed were greater in the unexpected versus the expected condition. In addition, trunk muscle fatigue led to an increase in the baseline activity of the trunk muscles but no additional increase in activity just prior to loading. There was increased activation of both (opposing) muscle groups when only one muscle group was fatigued. Because the peak responses following the perturbation were enhanced in the unknown timing condition, preparations must have taken place prior to the anticipated perturbations, perhaps in other segments of the body that were not measured. Also, the load impact may not have been great enough to elicit large preparations. The heightened baseline activity with fatigue suggests that there may have been increased spinal stiffness whenever the spine was fatigued, and not just immediately prior to an impending perturbation. The increased activation of opposing muscle groups is evidence of increased cocontraction in response to fatigue, possibly to maintain stability with decreasing coordination.