Use of lumbar trunk muscles in isometric performance of mechanically complex standing tasks

Ten subjects performed 25 tasks isometrically while standing. Those tasks imposed substantial extension, lateral bending, and twisting moments on the lumbar spine. Mechanically complex trunk muscle actions were called for to resist those moments. Biomechanical model analyses were used to predict the trunk muscle contraction forces needed to perform those tasks, and surface myoelectric activities were measured to validate those predictions. Predictions and measurements were linearly well correlated.     

Quantitative studies of the flexion-relaxation phenomenon in the back muscles

In quiet standing positions involving substantial trunk flexion, myoelectric activity in the back muscles diminishes to low levels. Aspects of that "flexion-relaxation" phenomenon were explored through measurements of myoelectric activities in 11 young men during performance of 19 isometric tasks in flexed positions. Biomechanical model analyses were used to predict the internal loads imposed on the lumbar trunk structures during those performances. Flexion-relaxation consistently occurred in quiet flexed standing, but marked increases in myoelectric activity were found on imposition of external loads in flexed positions. Increases in myoelectric activity per unit increase in back muscle contraction force increase were nearly the same as those found in upright postures. Whether or not flexion-relaxation occurs, large trunk flexions load the spine heavily.     

Loads on the lumbar trunk during level walking

The goal of this study was to estimate the loads internal to the lumbar trunk that arise during level walking. To do this, (a) trunk muscle activities were calibrated in terms of muscle contraction force levels in a set of isometric exertions; (b) trunk muscle myoelectric activities were measured during level walking; and then (c) the muscle contraction forces that arose during walking were calculated from these measurements and calibrations. Lumbar trunk muscle myoelectric activities were quantified in 10 healthy young males. Myoelectric activities were monitored using eight bipolar surface electrode pairs placed around the trunk at the level of the third lumbar vertebrae. The subjects first performed four static weight-resisting tasks to calibrate muscle force/activity relationships. They then traversed a 8.25 m walkway three times each at cadences of 72 and 120 steps/min. A biomechanical model incorporating 22 lumbar trunk muscles was used to predict muscle contraction forces for the calibration tasks. Predicted forces were linearly correlated with the measured myoelectric activities for these tasks. The regression equations were then interpolated to estimate the muscle contraction forces from the myoelectric data during gait. Peak contraction forces for the iliocostalis muscles were calculated to be approximately 55 N per side, corresponding to total erector spinae peak contractions on the order of 140 N per side. For the other six muscles that were monitored, contraction forces were less than 15 N per side. This suggests that peak net reaction moments and peak spine compressions on the lumbar trunk during these walking tasks were on the order of 15 Nm and 1.2 times body weight, respectively.     

Analysis and measurement of neck loads

To examine the loads imposed on the structures of the neck by the performance of physical tasks, a biomechanical model of the neck was constructed. The model incorporated 14 bilateral pairs of muscle equivalents crossing the C4 level. A double linear programming optimization scheme that minimized maximum muscle contraction intensity and then vertebral compression force while equilibrating external loads was used to calculate the muscle contraction forces required and the motion segment reactions produced by task performance. To test model validity, 14 healthy adult subjects performed a series of isometric tasks requiring use of their neck muscles. These tasks included exertions in attempted flexion, extension, and left and right lateral bending and twisting. Subjects exerted maximum and submaximum voluntary efforts. During the performance, surface myoelectric activities were recorded at eight locations around the periphery of the neck at the C4 level. Calculated forces and measured myoelectric activities were then linearly correlated. Mean measured voluntary neck strengths in 10 male subjects were as large as 29.7 Nm. Four female subjects developed mean strengths that were approximately 60%-90% of those of the males. In both sexes, neck muscle strengths were approximately one order of magnitude lower than previously measured lumbar trunk strengths. Mean calculated neck muscle contraction forces ranged to 180 N. Mean calculated compression forces on the C4-5 motion segment ranged to 1164 N, lateral shear forces ranged to 125 N, and anteroposterior shear forces ranged to 135 N. Correlation coefficients between the calculated muscle forces and the measured myoelectric activities were as large as 0.85 in some muscles, but generally were smaller than this.     

Trunk muscle and lumbar ligament contributions to dynamic lifts with varying degrees of trunk flexion

This study was done to assess the interplay between muscular and ligamentous sources of extensor moment during dynamic lifting with various loads and flexion angles of the trunk segment for 15 subjects lifting a total of 150 loads. Ligament forces predicted from an anatomically detailed biomechanical model did not generally contribute more than 60 Nm for most of the lifts because the lumbar spine was only flexed to a moderate and constant degree for each load condition. In contrast, additional moment demands associated with increases in hand load were supported by muscle. Although the compression forces on the L4-5 intervertebral disc were fairly insensitive to the interplay between the recruitment of muscle and ligament, the shear force was significantly higher with a greater degree of lumbar flexion. The risk of injury may be influenced more by the degree of lumbar flexion than the choice of stoop or squat technique.     

Trunk muscle myoelectric activities in idiopathic scoliosis

Twenty adolescent girls with mild-to-moderate cases of idiopathic scoliosis and twelve adolescent girls with structurally normal spines performed 15 exercises isometrically while standing. The exercises included resisting flexion, extension, and lateral bending moments imposed on the trunk. Myoelectric activities in 12 trunk muscle groups were measured during these performances, using surface electrodes. For one set of comparisons, the patients were divided into those whose clinical records documented curve progression and those with no documented progression. No significant differences were noted in mean myoelectric activities between these two patient groups. For a second set of comparisons, the subjects were divided into patients with curves of more than 25 degrees, patients with curves of 25 or fewer degrees and normals. No significant differences in mean myoelectric activities were noted between the patients with the smaller curves, while the patients with the larger curves had significantly larger convex side myoelectric activities in their anterior, lateral and posterior muscles at lumbar levels compared to the normal girls. The findings of this study, along with biomechanical model analyses, suggest that the asymmetries in muscle actions evidenced by myoelectric measurements result from scoliosis. Scoliosis progression seems not to be caused by asymmetry in muscle contractions; rather it may be caused by a lack of adequate asymmetry.     

Analysis of squat and stoop dynamic liftings: muscle forces and internal spinal loads

Despite the well-recognized role of lifting in back injuries, the relative biomechanical merits of squat versus stoop lifting remain controversial. In vivo kinematics measurements and model studies are combined to estimate trunk muscle forces and internal spinal loads under dynamic squat and stoop lifts with and without load in hands. Measurements were performed on healthy subjects to collect segmental rotations during lifts needed as input data in subsequent model studies. The model accounted for nonlinear properties of the ligamentous spine, wrapping of thoracic extensor muscles to take curved paths in flexion and trunk dynamic characteristics (inertia and damping) while subject to measured kinematics and gravity/external loads. A dynamic kinematics-driven approach was employed accounting for the spinal synergy by simultaneous consideration of passive structures and muscle forces under given posture and loads. Results satisfied kinematics and dynamic equilibrium conditions at all levels and directions. Net moments, muscle forces at different levels, passive (muscle or ligamentous) forces and internal compression/shear forces were larger in stoop lifts than in squat ones. These were due to significantly larger thorax, lumbar and pelvis rotations in stoop lifts. For the relatively slow lifting tasks performed in this study with the lowering and lifting phases each lasting ∼2 s, the effect of inertia and damping was not, in general, important. Moreover, posterior shift in the position of the external load in stoop lift reaching the same lever arm with respect to the S1 as that in squat lift did not influence the conclusion of this study on the merits of squat lifts over stoop ones. Results, for the tasks considered, advocate squat lifting over stoop lifting as the technique of choice in reducing net moments, muscle forces and internal spinal loads (i.e., moment, compression and shear force).     

Valsalva maneuver biomechanics. Effects on lumbar trunk loads of elevated intraabdominal pressures

The ability of a partial or full Valsalva maneuver (voluntary pressurization of the intraabdominal cavity) to unload the spine was investigated in four subjects. During the performance of five isometric tasks, intraabdominal and intradiscal pressures and surface myoelectric activities in three lumbar trunk muscle groups were measured. The tasks were carried out without voluntary pressurization of the intraabdominal cavity and then when the subjects performed partial and full Valsalva maneuvers. A biomechanical model analysis of each task was made to help interpret the experimental measurements. Intraabdominal pressure was found not to be an indicator of spine load in these experiments. The Valsalva maneuvers did raise intraabdominal pressure, but in four of the five tasks increased rather than decreased lumbar spine compressions occurred.     

Cost-benefit of muscle cocontraction in protecting against spinal instability

STUDY DESIGN: Lifting dynamics and electromyographic activity were evaluated using a biomechanical model of spinal equilibrium and stability to assess cost-benefit effects of antagonistic muscle cocontraction on the risk of stability failure. OBJECTIVES: To evaluate whether increased biomechanical stability associated with antagonistic cocontraction was capable of stabilizing the related increase in spinal load. SUMMARY OF BACKGROUND DATA: Antagonistic cocontraction contributes to improved spinal stability and increased spinal compression. For cocontraction to be considered beneficial, stability must increase more than spinal load. Otherwise, it may be possible for cocontraction to generate spinal loads that cannot be stabilized. METHODS: A biomechanical model was developed to compute spinal load and stability from measured electromyography and motion dynamics. As 10 healthy men performed sagittal lifting tasks, trunk motion, reaction loads, and electromyographic activities of eight trunk muscles were recorded. Spinal load and stability were evaluated as a function of cocontraction and trunk flexion angle. Stability was quantified in terms of the maximum spinal load the system could stabilize. RESULTS: Cocontraction was associated with a 12% to 18% increase in spinal compression and a 34% to 64% increase in stability. Spinal load and stability increased with trunk flexion. CONCLUSIONS: Despite increases in spinal load that had to be stabilized, the margin between stability and spinal compression increased significantly with cocontraction. Antagonistic cocontraction was found to be most beneficial at low trunk moments typically observed in upright postures. Similarly, empirically measured antagonistic cocontraction was recruited less in high-moment conditions and more in low-moment conditions.     

An electromyography-assisted model to estimate trunk muscle forces during fatiguing repetitive trunk exertions

During submaximal shortening muscle contraction, fatigue characteristically results in an increase in measured surface electromyography, whereas the maximum force that can be produced by muscle is reduced. This finding compromises researchers' ability to estimate muscle stress in a joint system such as the spine, which is composed of more muscles than degrees of freedom of the joint. A three-dimensional, electromyography-assisted, dynamic biomechanical model of spinal loading was developed and validated for use during fatiguing repetitive trunk extension exertions. A time-varying maximum muscle stress was included to model the effect of a change in the maximum force-producing capacity of the erector spinae muscle. Sixteen men performed submaximal isokinetic trunk extension endurance tests at 15 degrees per second. The exertion level (35% and 70% of their maximum dynamic extension torque) and repetition rate (5 and 10 repetitions per minute) of the tests were varied during four testing sessions. Using trunk muscle electromyography and the measured torque as input, the model predicted significant linear reductions in the maximum muscle stress in 78% of the endurance tests, which resulted in an estimated decrease in erector spinae force in 75% of the tests. Conversely, if the maximum muscle stress was assumed to be constant, the erector spinae force would have been predicted to increase in 73% of the tests. The magnitude of the change in predicted erector spinae maximum muscle stress and force depended on the exertion level and repetition rate. This model will allow researchers to assess the effects of changes in recruitment patterns of trunk muscles during dynamic trunk extension on the estimated spinal loading of the lumbar spine.     

Large compressive preloads decrease lumbar motion segment flexibility

The bending, shear, and torsion flexibilities of 13 intact adult lumbar motion segments (from 11 men, two women, 48-83 years of age) were compared under three different compressive preloads, 0, 2,200, and 4,400 N. Test forces and moments up to 160 N and 16 Nm were applied at the center of the upper end plate of the intact disc. A compressive preload of 2,200 N resulted in a significant decrease in motion segment flexibilities in all seven test directions (p less than 0.06) when compared with results obtained with no preload; the preload decreased flexibility 2.6, 4.5, and 6.1 times in bending, axial torsion, and shear, respectively. These results suggest that studies of internal trunk load-sharing between active and passive tissues during strenuous tasks, which engender large spine compressive loads, should take these changes in spine passive resistance into consideration.     

The activity of individual trunk muscles during heavy physical loading

The myoelectric activity of ten trunk muscles were recorded, using intramuscular electrodes, when ten subjects made maximal and 50% of maximal static exertions in standing postures. Exertions were made in flexion, extension, and left and right lateral bending. Three heavy-lifting tasks also were studied. A biomechanical model was used to predict the forces in the trunk muscles, and the predictions then were compared to the measurements. The abdominal muscles were all active in attempted flexion, while the erector spinae muscles were inactive. In attempted extension, the erectors were maximally active, but considerable activity was present in the abdominal muscles as well. The highest activity levels recorded in the oblique abdominal muscles were in lateral bending. There were high degrees of correlation between the measured muscle activities and predicted muscle tensions for the erector spinae and rectus abdominus muscles, while the correlation coefficients for the oblique abdominal muscles were lower (0.4-0.7). The study indicates that inclusion of antagonistic activity is an important consideration to improve model predictions. The oblique abdominal muscles appear to be more active, in general, than predicted. For the longitudinal trunk muscles, the predictions are excellent throughout.     

Co-contraction of lumbar muscles during the development of time-varying triaxial moments

The recruitment and co-contraction of lumbar muscles were investigated during the voluntary development of slowly and rapidly varying trunk flexion and extension, lateral bending, and axial twisting moments. Myoelectric signals were recorded from 14 lumbar muscles in nine young men during maximum voluntary exertions and cyclic isometric exertions. System identification techniques were used to calibrate dynamic models of the relationship between myoelectric signals and force. To assess co-contraction, the predicted muscle forces were subdivided into a task-moment set of muscle forces that minimally satisfied moment equilibrium and a co-contraction set of muscle forces that produced zero net moment. The sum of co-contraction muscle forces was used to quantify the degree of co-contraction present. Co-contraction was largely dependent on the direction of exertion and relatively less dependent on the subject or the rate of exertion. Co-contractions were estimated to contribute approximately 16–19% to the sum of muscle forces at a lumbar cross section during attempted extension of the trunk. Estimated co-contractions during attempted lateral bending and axial twisting were two to three times greater, which demonstrates that co-contraction is a major determinant of spinal loading in these tasks. This analysis suggests that substantial contractions of lumbar muscles, especially during asymmetric exertions, are used for reasons other than equilibrating moments at the L3-L4 level.     

Quantitative analysis of the effect of lumbar orthosis on trunk muscle strength and muscle activity in normal subjects

 We studied the effect of lumbar orthosis on trunk muscle strength and muscle activity during flexion-extension bending of the trunk in 31 male volunteers. Trunk muscle strength was measured with a kinetic measurement system. Peak torque was calculated by using the mean torque of five repetitions. Trunk muscle activity was measured with commercially available equipment that has portable EMG data-collection units. The maximum level of the EMG signal was evaluated by employing the analyzing part of the computer's measuring program. With the application of the lumbar orthosis, the strength of the abdominal muscle and the back muscle increased; conversely, the activities of both muscles were decreased significantly. This might imply that lumbar orthosis reduces the load of the trunk muscles during performance. Received: October 5, 2001 / Accepted: February 12, 2002     

The effects of lumbosacral orthoses on spine stability: What changes in EMG can be expected?

Antagonistic trunk muscle activity is normally required to stabilize the spine. A lumbosacral orthosis (LSO) might reduce the need for this antagonistic activity by providing passive stiffness to the trunk and increasing spine stability. The maximum reduction in trunk muscle EMG and in the resultant spine compression force due to the LSO was estimated using a biomechanical model. The lumbar spine stability was first quantified for the average trunk muscle EMG recorded from 11 male subjects performing various isometric trunk exertion tasks. Subsequently, the spine-stiffening effects of the LSO were implemented in the model and trunk muscle forces were reduced iteratively until the original level of spine stability without the LSO was achieved. The upper bound estimates of the reduction in trunk muscle EMG due to LSO ranged from 0.6% to 14.1% of the maximum voluntary activation depending on the task and the muscle. The resultant spine compression force averaged across all tasks decreased by only 355 N. A much larger variance of the experimental data precluded the detection of these effects at statistically significant levels. However, the small effects size does not necessarily exclude the possibility of functional benefits of slightly reducing muscle activity in patients with low back pain.     

Estimating apparent maximum muscle stress of trunk extensor muscles in older adults using subject‐specific musculoskeletal models

Maximum muscle stress (MMS) is a critical parameter in musculoskeletal modeling, defining the maximum force that a muscle of given size can produce. However, a wide range of MMS values have been reported in literature, and few studies have estimated MMS in trunk muscles. Due to widespread use of musculoskeletal models in studies of the spine and trunk, there is a need to determine reasonable magnitude and range of trunk MMS. We measured trunk extension strength in 49 participants over 65 years of age, surveyed participants about low back pain, and acquired quantitative computed tomography (QCT) scans of their lumbar spines. Trunk muscle morphology was assessed from QCT scans and used to create a subject‐specific musculoskeletal model for each participant. Model‐predicted extension strength was computed using a trunk muscle MMS of 100 N/cm². The MMS of each subject‐specific model was then adjusted until the measured strength matched the model‐predicted strength (±20 N). We found that measured trunk extension strength was significantly higher in men. With the initial constant MMS value, the musculoskeletal model generally over‐predicted trunk extension strength. By adjusting MMS on a subject‐specific basis, we found apparent MMS values ranging from 40 to 130 N/cm², with an average of 75.5 N/cm² for both men and women. Subjects with low back pain had lower apparent MMS than subjects with no back pain. This work incorporates a unique approach to estimate subject‐specific trunk MMS values via musculoskeletal modeling and provides a useful insight into MMS variation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:498–505, 2018.     

Effect of the sympathetic nerve on the skeletal muscle blood flow at rest, during and after contraction

The effects of the sympathetic nerve on the muscle blood flow were studied on the quadriceps muscles of anesthetized rabbits. The muscle blood flow was measured by heated thermocouple technique, electrolytic hydrogen clearance method and laser doppler flowmetry. There was significant correlation in the muscle blood flow measured by the above three methods. After blockage of the neuro-muscular junction with pancuronium bromide, the femoral nerve stimulations with pulse duration 0.1 msec, 6 V, at 2, 5 and 10 Hz caused no change in the muscle blood flow, while the stimulation with pulse duration 1 msec, 6 V, at 10 Hz caused reduction of the muscle blood flow. The higher the frequency of lumbar sympathetic trunk stimulation was, the lower the muscle blood flow became thus the longer the recovery time was. When femoral nerve and lumbar sympathetic trunk were stimulated simultaneously, increment of muscle blood flow during contraction became less prominent, especially, with a stimulation of 5 Hz, which caused a decrement of post-contraction hyperemia both in height and duration. These results suggest that sympathetic nerve activities have an influence on the muscle blood flow at rest, as well as during and after muscle contraction.     

Electromyography of scoliotic patients treated with a brace.

When a brace is used to correct spinal deviation, patients may seek to ease the discomfort from the pressure exerted by the orthosis by actively recruiting specific trunk muscles. The effect of bracing on trunk electromyography (EMG) has been reported in only one study where a limited number of electrodes were placed mainly in the thoracic region. Our hypothesis was that a multi-electrode mapping of the activity of the thoracic, lumbar, and abdominal trunk muscles would provide a more representative picture of the muscular reaction in response to bracing. With a larger number of EMG measuring sites, the presence of any brace-induced trunk muscle activity should be detected. Therefore, EMG signals of 11 adolescent idiopathic scoliosis patients who had been undergoing Boston brace treatment for 0.7-3 years were collected during four isometric tasks to evaluate the response of trunk muscles in the minutes following the application of the brace. Twenty-two pairs of bipolar electrodes were used to measure the EMG signals of the main superficial trunk muscles during four isometric tasks. EMG signals of trunk muscles were compared in braced and unbraced conditions. Brace-induced increases in EMG activity were significant in 43% of the individual measurements and in three of the four tasks for the group mean values. Increases were greater in the lumbar area, especially on the convex side of the secondary (lumbar) curve. These results thus suggest that immediately following the application of the brace, significant muscular responses can be observed in some patients.     

Incorporation of CT‐based measurements of trunk anatomy into subject‐specific musculoskeletal models of the spine influences vertebral loading predictions

We created subject‐specific musculoskeletal models of the thoracolumbar spine by incorporating spine curvature and muscle morphology measurements from computed tomography (CT) scans to determine the degree to which vertebral compressive and shear loading estimates are sensitive to variations in trunk anatomy. We measured spine curvature and trunk muscle morphology using spine CT scans of 125 men, and then created four different thoracolumbar spine models for each person: (i) height and weight adjusted (Ht/Wt models); (ii) height, weight, and spine curvature adjusted (+C models); (iii) height, weight, and muscle morphology adjusted (+M models); and (iv) height, weight, spine curvature, and muscle morphology adjusted (+CM models). We determined vertebral compressive and shear loading at three regions of the spine (T8, T12, and L3) for four different activities. Vertebral compressive loads predicted by the subject‐specific CT‐based musculoskeletal models were between 54% lower to 45% higher from those estimated using musculoskeletal models adjusted only for subject height and weight. The impact of subject‐specific information on vertebral loading estimates varied with the activity and spinal region. Vertebral loading estimates were more sensitive to incorporation of subject‐specific spinal curvature than subject‐specific muscle morphology. Our results indicate that individual variations in spine curvature and trunk muscle morphology can have a major impact on estimated vertebral compressive and shear loads, and thus should be accounted for when estimating subject‐specific vertebral loading. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2164–2173, 2017.