Extension Exertions Research Articles

Trunk stiffness and dynamics during active extension exertions

Spinal stability is related to the recruitment and control of active muscle stiffness. Stochastic system identification techniques were used to calculate the effective stiffness and dynamics of the trunk during active trunk extension exertions. Twenty-one healthy adult subjects (10 males, 11 females) wore a harness with a cable attached to a servomotor such that isotonic flexion preloads of 100, 135, and 170 N were applied at the T10 level of the trunk. A pseudorandom stochastic force sequence (bandwidth 0–10 Hz, amplitude ±30 N) was superimposed on the preload causing small amplitude trunk movements. Nonparametric impulse response functions of trunk dynamics were computed and revealed that the system exhibited underdamped second-order behavior. Second-order trunk dynamics were determined by calculating the best least-squares fit to the IRF. The quality of the model was quantified by comparing estimated and observed displacement variance accounted for (VAF), and quality of the second-order fits was calculated as a percentage and referred to as fit accuracy. Mean VAF and fit accuracy were 87.8 ± 4.0 % and 96.0 ± 4.3 % , respectively, indicating that the model accurately represented active trunk kinematic response. The accuracy of the kinematic representation was not influenced by preload or gender. Mean effective stiffness was 2.78 ± 0.96 N / mm and increased significantly with preload ( p < 0.001 ), but did not vary with gender ( p = 0.425 ). Mean effective damping was 314 ± 72 N s/m and effective trunk mass was 37.0 ± 9.3 kg . We conclude that stochastic system identification techniques should be used to calculate effective trunk stiffness and dynamics.

Effects of static flexion–relaxation on paraspinal reflex behavior

Background. Static trunk flexion working postures and disturbed trunk muscle reflexes are related to increased risk of low-back pain. Animal studies conclude that these factors may be related; passive tissue strain in spinal ligaments causes subsequent short-term changes in reflex. Although studies have documented changes in the myoelectric onset angle of flexion–relaxation following prolonged static flexion and cyclic flexion we could find no published evidence related to the human reflex response of the trunk extensor muscles following a period of static flexion–relaxation loading. Methods. Eighteen subjects maintained static lumbar flexion for 15 min. Paraspinal muscle reflexes were elicited both before and after the flexion–relaxation protocol using pseudorandom stochastic force disturbances while recording EMG. Reflex gain was computed from the peak value of the impulse response function relating input force perturbation to EMG response using time-domain deconvolution analyses. Findings. Reflexes showed a trend toward increased gain after the period of flexion–relaxation ( P < 0.055) and were increased with trunk extension exertion ( P < 0.021). Significant gender differences in reflex gain were observed ( P < 0.01). Interpretations. Occupational activities requiring extended periods of trunk flexion contribute to changes in reflex behavior of the paraspinal muscles. Results suggest potential mechanisms by which flexed posture work may contribute to low-back pain. Significant gender differences indicate risk analyses should consider personal factors when considering neuromuscular behavior.

Abnormal coupling of knee and hip moments during maximal exertions in persons with cerebral palsy.

The motions of lower-limb extension, adduction, and internal rotation are frequently coupled in persons with cerebral palsy (CP) and are commonly referred to as an extension synergy. However, the underlying joint moments that give rise to these coupled motions are not well understood. We hypothesized that maximal voluntary exertions in a direction of one component of a synergy (e.g., hip extension) would result in the concurrent presence of other components of the synergy in subjects with CP but not in control subjects. To test this hypothesis, we measured three-dimensional moments about the hip and knee as nine subjects with spastic CP and six control subjects performed maximal isometric exertions of the hip and knee flexors and extensors. During maximal hip extension exertions, control subjects simultaneously generated a knee flexion moment, whereas CP subjects generated a knee extension moment (P < 0.05) and a larger hip internal rotation moment than did controls (P < 0.05). During maximal knee extension exertions, control subjects generated a hip flexion moment, whereas CP subjects generated a hip extension moment (P < 0.05). The patterns of joint moments generated by CP subjects are consistent with an extension synergy and may underlie the coupled motion patterns of the lower extremity in such persons.

Identification of Measures Sensitive to Fatigue Development Associated with Low-Level Exertions of the Neck Musculature and the Effects of Age

This research had two purposes: to identify measures sensitive to fatigue development associated with low force, static exertions and to investigate the effects of aging on fatigue onset associated with low-level exertions of the neck musculature. Fourteen subjects participated ranging in age from 20 to 62 years. The task consisted of a submaximal neck extension exertion held until fatigue. Based on the results of this experiment, it was found that: ▪ Several measures are sensitive to fatigue induced during a low-level static exertion of the neck extensor muscles, including: discomfort, three EMG time domain and four frequency domain parameters ▪ when comparing groups based on age, results and interpretations of effects due to age may be directly be influenced by the choice of dependent measure (such as discomfort, maximum force, and potentially time to fatigue); ▪ regardless of age, some subjects may exhibit fatigue resistance at low exertions levels.

Gender differences in active musculoskeletal stiffness. Part I.: Quantification in controlled measurements of knee joint dynamics

Active females demonstrate increased risk for musculoskeletal injuries relative to equivalently-trained males. Although gender differences in factors such as passive laxity, skeletal geometry and kinematics have been examined, the effect of gender on active muscle stiffness has not been reported. Stiffness of the active quadriceps and hamstrings musculature were recorded during isometric knee flexion and extension exertions from twelve male and eleven female subjects. A second-order biomechanical model of joint dynamics was used to quantify stiffness from the transient motion response to an angular perturbation of the lower-leg. Female subjects demonstrated reduced active stiffness relative to male subjects at all torque levels, with levels 56–73% of the males. Effective stiffness increased linearly with the torque load, with stiffness increasing at a rate of 3.3 Nm/rad per unit of knee moment in knee flexion exertions (hamstrings) and 6.6 Nm/rad per unit of knee moment extension exertions (quadriceps). To account for gender differences in applied moment associated with leg mass, regressions analyses were completed that demonstrated a gender difference in the slope of stiffness-versus-knee moment relation. Further research is necessary to identify the cause of the observed biomechanical difference and implications for controlling injury.

Fatigue Induced Risk of Spinal Instability during Manual Materials Handling

Risk of occupational low-back disorders may be related to spinal stability achieved during manual materials handling. Stability is controlled and influenced by trunk muscle stiffness, antagonistic co-contraction and reflex response. Fatigue influences each of these factors, suggesting that fatigue may compromise spinal stability. A biomechanical model of spinal stability and experimental data were implemented to evaluate the effects of fatigue. EMG and trunk kinematics from 21 healthy subjects were recorded during static trunk extension exertions and sudden-load trials in fatigued and unfatigued states. The model predicted dramatic reduction in spinal stability associated with fatigue related decrement in paraspinal muscle stiffness and force generating capacity. Empirical data supported the model predictions, demonstrating increased antagonistic co-contraction during fatigued exertions. Results suggest risk of low-back injury from loss of spinal stability is increased during fatigue from manual materials handling.

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.

An empirical approach to characterizing trunk muscle coactivation using simulation input modeling techniques

Accurately describing trunk muscle coactivation is fundamental to quantifying the spine reaction forces that occur during lifting tasks and has been the focus of a great deal of research in the spine biomechanics literature. One limitation of previous approaches has been a lack of consideration given to the variability in these coactivation strategies. The research presented in this paper is an empirical approach to quantifying and modeling trunk muscle coactivation using simulation input modeling techniques. Electromyographic (EMG) data were collected from 28 human subjects as they performed controlled trunk extension exertions. These exertions included isokinetic (10 and 45°/s) and constant acceleration (50°/s/s) trunk extensions in symmetric and asymmetric (30°) postures at two levels of trunk extension moment (30 and 80 Nm). The EMG data were collected from the right and left pairs of the erector spinae, latissimus dorsi, rectus abdominis, external obliques and internal obliques. Each subject performed nine repetitions of each combination of independent variables. The data collected during these trials were used to develop marginal distributions of trunk muscle activity as well as a 10×10 correlation matrix that described how the muscles cooperated to produce these extension torques. These elements were then combined to generate multivariate distributions describing the coactivation of the trunk musculature. An analysis of these distributions revealed that increases in extension moment, extension velocity and sagittal flexion angle created increases in both the mean and the variance of the distributions of the muscular response, while increases in the rate of trunk extension acceleration decreased both the mean and variance of the distributions of activity across all muscles considered. Increases in trunk asymmetry created a decrease in mean of the ipsi–lateral erector spinae and an increase in the mean of all other muscles considered, but there was little change in the variance of these distributions as a function of asymmetry.

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.

Quantification of cocontraction in spastic cerebral palsy

Antagonist cocontraction was hypothesized to limit net moment production in children with spastic diplegic cerebral palsy (CP). A second hypothesis was that concontraction would vary with joint angle. To test these hypotheses, surface EMG activity and moment data from the quadriceps and hamstrings muscle groups were obtained from children with CP and compared with normally developing children during isometric flexion and extension exertions. A biomechanical model was developed to predict individual moments produced by the agonist and antagonist muscle groups. Concontraction was defined as the percentage of the net moment that was negated by the antagonist moment. The model performed well in predicting the measured moment as illustrated by high R2 correlation coefficients and low prediction errors. The mean maximum moment produced was greater in normally developing children than children with CP in both flexion and extension. Antagonist cocontraction during extension was greater in children with CP (12.2 +/- 14.4%) than in normally developing children (4.9 +/- 3.8%), implying that antagonist cocontraction is one explanation for the observed extension weakness in children with CP. However, during flexion, cocontraction was not significantly different between the two groups. Cocontraction differed significantly with joint angle in both groups during flexion and in the normally developing children during extension. Although quantifying coactivation based on EMG activity alone produced similar results, it underestimated the effect of the antagonist. The quantification of cocontraction has potential applications for characterizing spastic muscle dysfunction and thereby improving clinical outcomes in children with CP.

Effect of electromyogram-force relationships and method of gain estimation on the predictions of an electromyogram-driven model of spinal loading.

An experimental study of fatiguing isometric trunk extension was conducted to investigate the spinal loading estimated from an electromyogram-assisted biomechanical model. To evaluate the sensitivity of the model outputs to two crucial assumptions: electromyogram-force relationship and method of gain estimation. In the proposed electromyogram-assisted models of the trunk, the nature of the electromyogram-force relationship and the wide variation in reported muscle gains can result in a wide variation in estimates of spinal loading. Given the absence of any gold standard for validation of muscle forces, the delineation of confidence intervals for the estimated loads has become critical. Ten subjects performed a fatiguing isometric trunk extension while the net muscular torque output and trunk muscular activity were measured. An electromyogram-assisted model was used to estimate the torque output and spinal loading. Linear and nonlinear erector spinae electromyogram-force relationships and three methods for gain estimation were investigated: constant gain determined from an initial maximum extension exertion, constant gain based on the fatiguing exertion, and a time-varying gain from the fatigue test. The predicted torque was not sensitive to the electromyogram-force relationship; the nonlinear model produced 10% lower estimates of peak spinal compression force and 14% higher estimates of peak anterior shear force. The gain determined from an initial calibration exertion underestimated the external torque and underpredicted the peak compression force by 20%, compared with gains calculated in the fatigue test. The nature of the electromyogram-force relationship and of the method for estimating the gain significantly affect the outcomes of an electromyogram-assisted model of spinal loading.

Trunk extension strength and muscle activity in standing and kneeling postures.

A split-plot experimental design was used to evaluate the influence of posture, trunk angle, and rotational velocity on peak torque output and myoelectric activity during maximal trunk extension maneuvers. To determine whether the kneeling posture alters extension torque capabilities in isometric and isokinetic exercises as compared with standing. Also, to ascertain whether recruitment of trunk muscles is modified by such a postural change. Factors such as workplace geometry may force workers to adopt awkward or unusual postures in the performance of manual tasks. An understanding of the limitations placed on strength in unconventional working postures is crucial to the proper design of jobs. Twenty-one healthy male subjects (mean age = 36 years +/- 7 SD) performed 12 trunk extension exertions in standing and kneeling postures. Isometric tests were performed at 22.5 degrees, 45 degrees, and 67.5 degrees of trunk flexion. Isokinetic tests were done at three velocities: 30 degrees/sec, 60 degrees/sec, and 90 degrees/sec. Electromyographic data were collected from eight trunk muscles to assess muscle recruitment under each condition. A priori orthogonal contrasts were specified for analysis of both torque and electromyographic data. The kneeling posture was associated with a 15% decrease in peak torque output when contrasted with standing: however, no concomitant change in trunk muscle activity was evident. Trunk hyperflexion (isometric tests) and increasing rotational velocity (isokinetic tests) were associated with reduced torque in both postures. Trunk muscle activity was primarily affected by changes in trunk angle and velocity of contraction. A reduced extensor capability exists in the kneeling posture, despite equivalent trunk muscle activity. The similar activation patterns in both postures suggest that the strength deficit does not result from alterations in trunk muscle function. Rather, it may be the consequence of a reduced capability to rotate the pelvis in the kneeling posture, due to a disruption of the biomechanical linkage of the leg structures.

The Use of the Multivariate Johnson Distributions to Model Trunk Muscle Coactivation

The accurate description of trunk muscle coactivation, and more specifically antagonist muscle activity, has recently been the focus of a great deal of research in the spine biomechanics literature. The research presented in this paper is an empirical approach to the problem. Electromyographic (EMG) data were collected from 28 subjects as they performed simulated lifting tasks. These EMG data were collected from the right and left pairs of the erector spinae, latissimus dorsi, rectus abdominis, external obliques and internal obliques as subjects performed a variety of trunk extension exertions. Nine repetitions of each combination of independent variables were performed by each subject. Included in these exertions were asymmetric postures and dynamic (isokinetic and constant acceleration) exertions. The data collected during these trials were used to develop marginal distributions of trunk muscle activity as well as a 10 × 10 correlation matrix that described how the muscles cooperated in the development of these extension torques. These elements were then combined to generate multivariate distributions describing the coactivation of the trunk musculature.

Intra-abdominal pressure during trunk extension motions

Objective. This study was designed to help interpret the biomechanical role of intraabdominal pressure during lifting type motions of the trunk.Design. An in vivo study was performed in which intra-abdominal pressure was observed as subject trunks were subjected to different dynamic trunk loading conditions common during industrial lifting.Background. There is a little consensus as to the biomechanical role of intraabdominal pressure during lifting. Previous studies have suggested that: it may assist in load relief when lifting, may be involved in trunk stability, and/or may be used as a measure fo spine loading. Thus, in general, our understanding of intra-abdominal pressure is rather poor.Methods. In this study intra-abdominal pressure was monitored using a radio pill in 114 subjects over a series of four experiments. Subject's trunks were subjected to different dynamic trunk symmetric and asymmetric trunk loading conditions that are common during industrial lifting tasks.Results. The results indicated that (1) intra-abdominal pressure increased to significant levels (above 10 mmHg) only when more than 54 Nm of trunk torque were supported; (2) intra-abdominal pressure increases monotonically (up to 150 mmHg) as a function of trunk velocity; and (3) under concentric conditions intra-abdominal pressure increases as a function of greater asymmetry, whereas, under eccentric conditions the response changes to a much lesser extent as asymmetry changes.Conclusions. These findings suggest that intra-abdominal pressure appears to be more a by-product of trunk muscle coactivation. Any mechanical advantage gained from intraabdominal pressure might be in the form of a preparatory action resulting from muscle coactivation that stiffens the trunk just prior to a rapid trunk extension exertion. This function may reinforce previous hypotheses regarding the stability role of intra-abdominal pressure.

Quantification of Hand Grip Force under Dynamic Conditions

A laboratory experiment was conducted to determine whether grip force capabilities are lower when the wrist is moved than in a static position. The purpose was to determine the wrist velocity levels and wrist postures that had the most significant effect on grip force. Maximum grip forces of five male and five female subjects were determined under both static and dynamic conditions. The dominant wrist of each subject was secured to a CYBEX II dynamometer and grip force was collected during isokinetic wrist deviations for four directions of motion (flexion to extension, extension to flexion, radial to ulnar, and ulnar to radial). Six different velocity levels were analyzed and grip forces were recorded at specific wrist positions throughout each range of movement. For flexion-extension motions, wrist positions from 45 degrees flexion to 45 degrees extension were analyzed whereas positions from 20 degrees radial deviation to 20 degrees ulnar deviation were studied for radial-ulnar activity. Isometric exertions were also performed at each desired wrist position. Results showed that, for all directions of motion, grip forces for all isokinetic conditions were significantly lower than for the isometric exertions. Lower grip forces were exhibited at extreme wrist flexion and extreme radial and ulnar positions for both static and dynamic conditions. The direction of motion was also found to affect grip strength; extension to flexion exertions produced larger grip forces than flexion to extension exertions and radial to ulnar motion showed larger grip forces than ulnar to radial deviation. Although, males produced larger grip forces than females in all exertions, significant interactions between gender and velocity were noted.

The quantification of EMG normalization error

Electromyography (EMG) and normalized EMG have been accepted as methods of quantifying the activity level of a muscle. Normalized EMG, in conjunction with the EMG/force relationship and muscle cross-sectional area data, allows researchers to estimate the amount of muscle force exerted across a joint. An accurate description of this muscle force is a critical input to models designed to describe the risk of injury of a task. In order to be able to make statements about the relative intensity of an EMG signal, researchers who use normalization procedures take a given EMG activity level, at a known joint angle, and relate it to some reference activity level obtained at that particular joint angle. However, there have been studies where the EMG activity of an unrestricted dynamic task, such as walking, cycling, performing an occupational task, etc., has been normalized with respect to an EMG value taken during a single maximum voluntary contraction performed at one reference joint angle. This practice will render inaccurate results because at different joint angles there are changes in the portion of the muscle within the viewing area of the electrode, as well as changes in the length/tension relationship of the muscle which would cause changes in the maximum EMG value. The present study was an attempt to quantify the errors associated with normalization relative to a reference EMG value collected at an arbitrary joint position. Four subjects performed a series of controlled trunk extension exertions. As they performed these exertions the EMG activities were collected for eight trunk muscles. The task EMG values that resulted were then: (1) all normalized with respect to the maximum EMG at a single arbitrary trunk angle and (2) each normalized with respect to that specific trunk angle's maximum EMG. The results show that for the primary trunk extensors (erector spinae) large errors (greater than 75%) resulted from normalization using a single reference point and the magnitude of these errors followed consistent patterns within subjects as a function of trunk angle.

Biomechanical Modeling of Asymmetric Lifting Tasks in Constrained Lifting Postures

Twelve subjects participated in an investigation of the biomechanical stresses of asymmetric lifting in stooped and kneeling postures. Three factors were manipulated in this study: Posture (stooped or kneeling), height of lift (35 or 70 cm), and weight of lift (15, 20, or 25 kg). Subjects were required to lift or lower a box every 10 seconds for a period of 2 minutes. Electromyography (EMG) of eight trunk muscles was collected during a lift in this period. The EMG data, normalized to maximum extension and flexion exertions in each posture, were input to a biomechanical model and used to predict compression and shear forces at the L3 level of the lumbar spine. Results from the EMG-driven biomechanical model indicated that compression was greater when lifting to a higher shelf (p &lt; 0.001), and indicated a significant interaction between posture and the weight of the lifting box (p &lt; 0.01). Peak lateral shear was not significantly affected by any main effects or interactions (p &lt; 0.05). Anterior shear was increased with increasing height of lift (p &lt; 0.001), and also by the posture x weight interaction (p &lt; 0.01). A multivariate analysis of variance (MANOVA) indicated a complex relationship for recruitment of the eight trunk muscles, with the triple interaction being significant (p &lt; 0.001). The results of this investigation will be used to evaluate safe loads for lifting in these restricted postures.