Analysis of muscle activation patterns during transitions into and out of high knee flexion postures

Increased risk of medial tibiofemoral osteoarthritis (OA) is linked to occupations that require frequent transitions into and out of postures which require high knee flexion (>90°). Muscle forces are major contributors to joint loading, and an association between compressive forces due to muscle activations and the degeneration of joint cartilage has been suggested. The purpose of this study was to evaluate muscle activation patterns of muscles crossing the knee during transitions into and out of full-flexion kneeling and squatting, sitting in a low chair, and gait. Both net and co-activation were greater when transitioning out of high flexion postures, with maximum activation occurring at knee angles greater than 100°. Compared to gait, co-activation levels during high flexion transitions were up to approximately 3 times greater. Co-activation was significantly greater in the lateral muscle group compared to the medial group during transitions into and out of high flexion postures. These results suggest that compression due to activation of the medial musculature of the knee may not be the link between high knee flexion postures and increased medial knee OA observed in occupational settings. Further research on a larger subject group and workers with varying degrees of knee OA is necessary.     

Investigation of the Differential Contributions of Superficial and Deep Muscles on Cervical Spinal Loads with Changing Head Postures

Cervical spinal loads are predominately influenced by activities of cervical muscles. However, the coordination between deep and superficial muscles and their influence on the spinal loads is not well understood. This study aims to document the changes of cervical spinal loads and the differential contributions of superficial and deep muscles with varying head postures. Electromyography (EMG) of cervical muscles from seventeen healthy adults were measured during maximal isometric exertions for lateral flexion (at 10°, 20° and terminal position) as well as flexion/extension (at 10°, 20°, 30°, and terminal position) neck postures. An EMG-assisted optimization approach was used to estimate the muscle forces and subsequent spinal loads. The results showed that compressive and anterior-posterior shear loads increased significantly with neck flexion. In particular, deep muscle forces increased significantly with increasing flexion. It was also determined that in all different static head postures, the deep muscle forces were greater than those of the superficial muscle forces, however, such pattern was reversed during peak efforts where greater superficial muscle forces were identified with increasing angle of inclination. In summary, the identification of significantly increased spinal loads associated with increased deep muscle activation during flexion postures, implies higher risks in predisposing the neck to occupationally related disorders. The results also explicitly supported that deep muscles play a greater role in maintaining stable head postures where superficial muscles are responsible for peak exertions and reinforcing the spinal stability at terminal head postures. This study provided quantitative data of normal cervical spinal loads and revealed motor control strategies in coordinating the superficial and deep muscles during physical tasks.     

Model and in vivo studies on human trunk load partitioning and stability in isometric forward flexions

To resolve the trunk redundancy to determine muscle forces, spinal loads, and stability margin in isometric forward flexion tasks, combined in vivo-numerical model studies was undertaken. It was hypothesized that the passive resistance of both the ligamentous spine and the trunk musculature plays a crucial role in equilibrium and stability of the system. Fifteen healthy males performed free isometric trunk flexions of approximately 40 degrees and approximately 65 degrees +/- loads in hands while kinematics by skin markers and EMG activity of trunk muscles by surface electrodes were measured. A novel kinematics-based approach along with a nonlinear finite element model were iteratively used to calculate muscle forces and internal loads under prescribed measured postures and loads considered in vivo. Stability margin was investigated using nonlinear, linear buckling, and perturbation analyses under various postures, loads and alterations in ligamentous stiffness. Flexion postures significantly increased activity in extensor muscles when compared with standing postures while no significant change was detected in between flexed postures. Compression at the L5-S1 substantially increased from 570 and 771 N in upright posture, respectively, for +/-180 N, to 1912 and 3308 N at approximately 40 degrees flexion, and furthermore to 2332 and 3850 N at approximately 65 degrees flexion. Passive ligamentous/muscle components resisted up to 77% of the net moment. In flexion postures, the spinal stability substantially improved due both to greater passive stiffness and extensor muscle activities so that, under 180 N, no muscle stiffness was required to maintain stability. The co-activity of abdominal muscles and the muscle stiffness were of lesser concern to maintain stability in forward flexion tasks as compared with upright tasks. An injury to the passive system, on one hand, required a substantial compensatory increase in active muscle forces which further increased passive loads and, hence, the risk of injury and fatigue. On the other hand, it deteriorated the system stability which in turn could require greater additional muscle activation. This chain of events would place the entire trunk active-passive system at higher risks of injury, fatigue and instability.     

Position sense in the lumbar spine with torso flexion and loading

Proprioception plays an important role in appropriate sensation of spine position, movement, and stability. Previous research has demonstrated that position sense error in the lumbar spine is increased in flexed postures. This study investigated the change in position sense as a function of altered trunk flexion and moment loading independently. Reposition sense of lumbar angle in 17 subjects was assessed. Subjects were trained to assume specified lumbar angles using visual feedback. The ability of the subjects to reproduce this curvature without feedback was then assessed. This procedure was repeated for different torso flexion and moment loading conditions. These measurements demonstrated that position sense error increased significantly with the trunk flexion (40%, p < .05) but did not increase with moment load (p = .13). This increased error with flexion suggests a loss in the ability to appropriately sense and therefore control lumbar posture in flexed tasks. This loss in proprioceptive sense could lead to more variable lifting coordination and a loss in dynamic stability that could increase low back injury risk. This research suggests that it is advisable to avoid work in flexed postures.     

Diaphragm length adjustments with body position changes in the awake dog

Sonomicrometry was used to measure end-expiratory length and tidal shortening of the costal and crural diaphragm in awake chronically instrumented dogs in the right lateral decubitus, standing, and sitting postures. End-expiratory length did not change significantly in standing but fell by 11.5% for the costal and by 14.4% for the crural segment in sitting, when compared with decubitus position. Tidal shortening of both segments did not change significantly in the three postures. From decubitus to sitting, diaphragmatic electromyogram (EMG) activity increased only in some dogs, not significantly for the group. The inspiratory swing of abdominal pressure was always positive in decubitus and negative in standing and sitting. In the latter two postures, abdominal pressure increased gradually during expiration and fell in inspiration, suggesting a phasic expiratory contraction of abdominal muscles. We conclude that diaphragmatic tidal shortening is maintained in the different postures assumed by the awake dog during resting breathing. It seems that the main compensatory mechanism for changes in diaphragmatic operational length is a phasic expiratory contraction of the abdominal muscles rather than an increase in diaphragmatic EMG activity.     

Posture-dependent trunk extensor EMG activity during maximum isometrics exertions in normal male and female subjects.

Posture-dependent trunk function data are important for appropriate normalization of submaximal trunk exertions, and is also necessary to define a more precise and specific use for strength testing in the prevention and diagnosis of spinal disorders. The aim of the current study was to quantify maximal effort trunk muscle extensor activity and trunk isometric extension torque over a functional range of sagittal standing postures. Twenty healthy, young adult male and female subjects performed isometric extension tasks over a sagittal posture range of -20 degrees extension to +50 degrees flexion, in 10 degrees increments. Erector spinae muscle activity was recorded bilaterally at the level of L3 using surface EMG electrodes. Isometric trunk extension torque was measured using a trunk dynamometer. EMG and trunk torque differed significantly between genders, but there were no differences between male and female subjects when the data were normalized with respect to the upright posture. For the combined male and female population, upright posture normalized L3 EMG activity (EMGn) and trunk extension torque (Tn) increased 1.7-fold and 3.5-fold, respectively, over the 70 degrees range of sagittal postures examined. The ratio (Tn/EMGn) increased two-fold (0.83 to 1.67) from -20 degrees extension to +50 degrees flexion, indicating that the neuromuscular efficiency increases with flexion. Trunk extension torque normalized with respect to the upright posture was linearly and positively correlated (r = 0.59, P < 0.001) to similarly normalized L3 EMG activity. This relatively weak correlation suggests that trunk muscle synergism and/or intrinsic muscle length-tension relationships are also modulated by posture. This study provides data that can be used to estimate trunk extensor muscle function over a broad range of sagittal postures. Our findings indicate that appropriate postural normalization of trunk extensor EMG activity is necessary for studies where submaximal trunk exertions are performed over a range of upright postures.     

Forces and moments on the knee during kneeling and squatting

Euler angle decomposition and inverse dynamics were used to determine the knee angles and net forces and moments applied to the tibia during kneeling and squatting with and without kneepads for 10 subjects in four postures: squatting (Squat), kneeling on the right knee (One Knee), bilateral kneeling near full flexion (Near Full) and bilateral kneeling near 90° flexion (Near 90). Kneepads affected the knee flexion (p = .002), medial forces (p = .035), and internal rotation moments (p = .006). Squat created loading conditions that had higher varus (p < .001) and resultant moments (p = .027) than kneeling. One Knee resulted in the highest force magnitudes and net moments (p < .001) of the kneeling postures. Thigh-calf and heel-gluteus contact forces decreased the flexion moment on average by 48% during Squat and Near Full.     

Regional activation of supraspinatus and infraspinatus sub-regions during dynamic tasks performed with free weights

Growing evidence supports the existence of distinct anatomical sub-regions within supraspinatus and infraspinatus, but only recently has attention turned to exploring their potential functional differences. Using indwelling fine-wire electromyography, muscle activity was investigated from these sub-regions in 15 participants (mean 34 yr, 170 cm, 71.9 kg) during dynamic external rotation (ER), abduction, flexion, and scaption tasks with and without free weights corresponding to 50% and 75% of the participant’s five repetition maximum. Electromyography data were normalized to isometric and isokinetic maximal voluntary contractions and activation ratios for each sub-region compared.Differences in mean regional activation ratios for supraspinatus and infraspinatus varied by arm posture, but were not influenced by load. Relative activation of posterior supraspinatus was greater during an ER task performed in side lying compared to an ER task performed with 90° of humeral elevation in seated and prone postures. Relative activation of superior infraspinatus was greater during an ER task in prone and side lying postures compared to flexion and scaption. Similar results were found when comparing regional muscle activation ratios for infraspinatus between tasks regardless of normalization method employed. These findings may impact exercise selection in the non-operative management of rotator cuff tears.     

Biomechanical modeling of deep squatting: Effects of the interface contact between posterior thigh and shank

Epidemiological studies indicate that occupational activities that require extended deep knee flexion or kneeling are associated with a higher prevalence of knee osteoarthritis. In many sport activities, such as a catcher in a baseball or a softball game, athletes have to make repetitive deep squatting motions, which have been associated with the development of osteochondritis dissecans. Excessive deep knee flexion postures may cause excessive loading in the knee joint. In deep knee flexion postures, the posterior aspect of the shank will contact the posterior thigh, resulting in a compressive force within the soft tissues. The current study was aimed at analyzing the effects of the posterior thigh/shank contact on the joint loading during deep knee flexion in a natural knee. An existing, whole body model with detailed anatomical components of the knee (AnyBody) has been adopted and modified for this study. The effects of the posterior thigh/shank contact were evaluated by comparing the results of the inverse dynamic analysis for two scenarios: with and without the posterior thigh/shank contact force. Our results showed that, in a deep squatting posture (knee flexion 120+ degrees), the posterior thigh/shank contact helps reduce the patellofemoral (PF) and tibiofemoral (TF) normal contact forces by 42% and 57%, respectively.     

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.     

Thigh-calf contact parameters for six high knee flexion postures: Onset,maximum angle,total force,contact area,and center of force

In high knee flexion, contact between the posterior thigh and calf is expected to decrease forces on tibiofemoral contact surfaces, therefore, thigh-calf contact needs to be thoroughly characterized to model its effect. This study measured knee angles and intersegmental contact parameters in fifty-eight young healthy participants for six common high flexion postures using motion tracking and a pressure sensor attached to the right thigh. Additionally, we introduced and assessed the reliability of a method for reducing noise in pressure sensor output. Five repetitions of two squatting, two kneeling, and two unilateral kneeling movements were completed. Interactions of posture by sex occurred for thigh-calf and heel-gluteal center of force, and thigh-calf contact area. Center of force in thigh-calf regions was farther from the knee joint center in females, compared to males, during unilateral kneeling (82 and 67 mm respectively) with an inverted relationship in the heel-gluteal region (331 and 345 mm respectively), although caution is advised when generalizing these findings from a young, relatively fit sample to a population level. Contact area was larger in females when compared to males (mean of 155.61 and 137.33 cm² across postures). A posture main effect was observed in contact force and sex main effects were present in onset and max angle. Males had earlier onset (121.0°) and lower max angle (147.4°) with onset and max angles having a range between movements of 8° and 3° respectively. There was a substantial total force difference of 139 N between the largest and smallest activity means. Force parameters measured in this study suggest that knee joint contact models need to incorporate activity-specific parameters when estimating loading.     

PLAD (personal lift assistive device) stiffness affects the lumbar flexion/extension moment and the posterior chain EMG during symmetrical lifting tasks

The PLAD (personal lift assistive device) was designed to reduce the lumbar moment during lifting and bending tasks via elastic elements. This investigation examined the effects of modulating the elastic stiffness. Thirteen men completed 90 lifts (15 kg) using 6 different PLAD stiffnesses in stoop, squat and freestyle lifting postures. The activity of 8 muscles were recorded (latissimus dorsi, thoracic and lumbar erector spinae, rectus abdominis, external oblique, gluteus maximus, biceps femoris and rectus femoris), 3D electromagnetic sensors tracked the motion of each segment and strain gauges measured the elastic tension. EMG data were rectified, filtered, normalized and integrated as a percentage of the lifting task. The highest PLAD tension elicited the greatest reduction in erector spinae activity (mean of thoracic and lumbar) in comparison to the no-PLAD condition for the stoop (37%), squat (38%), and freestyle (37%) lifts, while prompting comparable reductions in gluteus maximums and biceps femoris activity. The highest PLAD stiffness also elicited the greatest reduction in the integrated L4/L5 flexion moment for the stoop (19.0%), squat (18.4%) and freestyle (17.4%) lifts without changing peak lumbar flexion. Each increase in PLAD stiffness further reduced the muscle activity of the posterior chain and the dynamic lumbar moment.     

Thumb motor performance varies with thumb and wrist posture during single-handed mobile phone use

Design features of mobile computing technology such as device size and key location may affect thumb motor performance during single-handed use. Since single-handed use requires the thumb posture to vary with key location, we hypothesize that motor performance is associated with thumb and wrist joint postures. A repeated measures laboratory experiment of 10 right-handed participants measured thumb and wrist joint postures during reciprocal tapping tasks between two keys for different key pairs among 12 emulated keys. Fitts' effective index of performance and joint postures at contact with each key were averaged across trials for each key. Thumb motor performance varied for different keys, with poorest performances being associated with excessive thumb flexion such as when tapping on keys closest to the base of the thumb in the bottom right corner of the phone. Motor performance was greatest when the thumb was in a typical resting posture, neither significantly flexed nor fully extended with slight CMC joint abduction and supination, such as when tapping on keys located in the top right and middle left areas on the phone. Grip was also significantly affected by key location, with the most extreme differences being between the top left and bottom right corners of the phone. These results suggest that keypad designs aimed at promoting performance for single-handed use should avoid placing frequently used functions and keys close to the base of the thumb and instead should consider key locations that require a thumb posture away from its limits in flexion/extension, as these postures promote motor performance.     

EMG in rotation–flexion of the torso

The objective of this study was to determine the magnitude and phasic relationship of the torso muscles in rotation–flexion of varying degree of asymmetries of the trunk. Nineteen normal young subjects (7 males and 12 females) were stabilized on a posture stabilizing platform and instructed to assume a flexed and right rotated posture. A combination 20°, 40° and 60° of rotation and 20°, 40° and 60° of flexion resulted in nine postures. These postures were assumed in a random order. The subjects were asked to exert their maximal voluntary isometric contraction (MVC) in the plane of rotation of the posture assumed for a period of 5 s. The surface EMG from the external and internal obliques, rectus abdominis, latissimus dorsi and erector spinae at the 10th thoracic and 3rd lumbar vertebral levels was recorded. The abdominal muscles had the least response at 40° of flexion, the dorsal muscles had the highest magnitude.With increasing right rotation, the left external oblique continued to decrease its activity. The ANOVA revealed that rotation and muscles had a significant main effect on normalized peak EMG (p < 0.02) in both genders. There was a significant interaction between rotation and flexion in both genders (p < 0.02) and rotation and muscle in females. The erector spinae activity was highest at 40° flexion, due to greater mechanical disadvantage and having not reached the state of flexion–relaxation. The abdominal muscle activity declined with increasing asymmetry, due to the decreasing initial muscle length. The EMG activity was significantly affected by rotation than flexion (p < 0.02).     

Neck muscle paths and moment arms are significantly affected by wrapping surface parameters

In this paper, we studied the effects of wrapping surfaces on muscle paths and moment arms of the neck muscle, semispinalis capitis. Sensitivities to wrapping surface size and the kinematic linkage to vertebral segments were evaluated. Kinematic linkage, but not radius, significantly affected the accuracy of model muscle paths compared to centroid paths from images. Both radius and linkage affected the moment arm significantly. Wrapping surfaces that provided the best match to centroid paths over a range of postures had consistent moment arms. For some wrapping surfaces with poor matches to the centroid path, a kinematic method (tendon excursion) predicted flexion moment arms in certain postures, whereas geometric method (distance to instant centre) predicted extension. This occurred because the muscle lengthened as it wrapped around the surface. This study highlights the sensitivity of moment arms to wrapping surface parameters and the importance of including multiple postures when evaluating muscle paths and moment arm.     

Neck muscle paths and moment arms are significantly affected by wrapping surface parameters

In this paper, we studied the effects of wrapping surfaces on muscle paths and moment arms of the neck muscle, semispinalis capitis. Sensitivities to wrapping surface size and the kinematic linkage to vertebral segments were evaluated. Kinematic linkage, but not radius, significantly affected the accuracy of model muscle paths compared to centroid paths from images. Both radius and linkage affected the moment arm significantly. Wrapping surfaces that provided the best match to centroid paths over a range of postures had consistent moment arms. For some wrapping surfaces with poor matches to the centroid path, a kinematic method (tendon excursion) predicted flexion moment arms in certain postures, whereas geometric method (distance to instant centre) predicted extension. This occurred because the muscle lengthened as it wrapped around the surface. This study highlights the sensitivity of moment arms to wrapping surface parameters and the importance of including multiple postures when evaluating muscle paths and moment arm.     

Support for a linear length-tension relation of the torso extensor muscles: An investigation of the length and velocity EMG-force relationships

This study investigated the hypothesis that the length-tension relation of the torso erectors would be linear, mirroring the observed linear increase in extension strength capability toward full flexion. The effect of torso extension velocity on the tension capability of these muscles was also investigated for common motion speeds. A myoelectric-based approach was used wherein a dynamic biomechanical model incorporating active and passive tissue characteristics provided muscle kinematic estimates during controlled sagittal plane extension motions. A double linear optimization formulation from the literature provided muscle tension estimates. The data of five male subjects supported the hypothesis of a linear length-tension relation toward full flexion for both the erector spinae and latissimus muscles. Velocity trends agreed with that predicted by Hill's exponential relation, although linear trends were found to fit the data almost as well. The results have implications for muscle tension estimation in biomechanical torso modeling, and suggest a possible low back pain injury mechanism through tissue strain while lifting in fully flexed postures.     

A model-based study of passive joint properties on muscle effort during static stance

This study examined the impact of lower extremity joint stiffnesses and simulated joint contractures on the muscle effort required to maintain static standing postures after a spinal cord injury (SCI). Static inverse computer simulations were performed with a three-dimensional 15 degree of freedom musculoskeletal model placed in 1600 different standing postures. The required lower extremity muscle forces were calculated through an optimization routine that minimized the sum of the muscle stresses squared, which was used as an index of the muscle effort required for each standing posture. Joint stiffnesses were increased and decreased by 100 percent of their nominal values, and contractures were simulated to determine their effects on the muscle effort for each posture. Nominal muscle and passive properties for an individual with a SCI determined the baseline muscle effort for comparisons. Stiffness changes for the ankle plantar flexion/dorsiflexion, hip flexion/extension, and hip abduction/adduction directions had the largest effect on reducing muscle effort by more than 5 percent, while changes in ankle inversion/eversion and knee flexion/extension had the least effect. For erect standing, muscle effort was reduced by more than 5 percent when stiffness was decreased at the ankle plantar flexion/dorsiflexion joint or hip flexion/extension joint. With simulated joint contractures, the postural workspace area decreased and muscle effort was not reduced by more than 5 percent for any posture. Using this knowledge, methods can be developed through the use of orthoses, physical therapy, surgery or other means to appropriately augment or diminish these passive moments during standing with a neuroprosthesis.     

Do Postures of Distal Effectors Affect the Control of Actions of Other Distal Effectors? Evidence for a System of Interactions between Hand and Mouth

The present study aimed at determining whether, in healthy humans, postures assumed by distal effectors affect the control of the successive grasp executed with other distal effectors. In experiments 1 and 2, participants reached different objects with their head and grasped them with their mouth, after assuming different hand postures. The postures could be implicitly associated with interactions with large or small objects. The kinematics of lip shaping during grasp varied congruently with the hand posture, i.e. it was larger or smaller when it could be associated with the grasping of large or small objects, respectively. In experiments 3 and 4, participants reached and grasped different objects with their hand, after assuming the postures of mouth aperture or closure (experiment 3) and the postures of toe extension or flexion (experiment 4). The mouth postures affected the kinematics of finger shaping during grasp, that is larger finger shaping corresponded with opened mouth and smaller finger shaping with closed mouth. In contrast, the foot postures did not influence the hand grasp kinematics. Finally, in experiment 5 participants reached-grasped different objects with their hand while pronouncing opened and closed vowels, as verified by the analysis of their vocal spectra. Open and closed vowels induced larger and smaller finger shaping, respectively. In all experiments postures of the distal effectors induced no effect, or only unspecific effects on the kinematics of the reach proximal/axial component. The data from the present study support the hypothesis that there exists a system involved in establishing interactions between movements and postures of hand and mouth. This system might have been used to transfer a repertoire of hand gestures to mouth articulation postures during language evolution and, in modern humans, it may have evolved a system controlling the interactions existing between speech and gestures.     

Effect of posture on vital capacity

The influence of some extreme body postures on vital capacity (VC) was examined in young adult humans. Two postures required full support of body weight by the arms: arms up, hanging from a bar, and arms down with hands gripping parallel bars. Three involved muscles that flex and extend the trunk: a partial sit-up position while supine and nearly maximal spinal extension and flexion while standing. Changes at the inspiratory and expiratory volume extremes were recognized by having the subjects do two VC efforts: the first standing and the second in the posture in question while continuing to breathe on the spirometer. Control observations in which the second of a VC pair was performed in an unstressed posture allowed correction for the influence of rebreathing. The changes in corrected VC were small, the greatest being an average reduction of approximately 8% in the partial sit-up position. During full support of body weight by the arms, the VC was slightly increased due to a significant increase in the inspiratory extreme and no change in the expiratory extreme. Spinal extension produced small increases in lung volume at both extremes with no significant change in VC, whereas spinal flexion did not influence the upper extreme but did increase lung volume at the lower extreme. The changes are discussed in terms of trunk muscle action.