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Study design Numerical in-silico human spine stability finite element analysis. Objective The purpose of this study was to investigate the contribution of major torso tissues toward static spine stability, mainly the thoracolumbar fascia (TLF), abdominal wall with its intra-abdominal pressure (IAP), and spinal muscles inclusive of their intramuscular pressure. Summary of background data Given the numerous redundancies involved in the spine, current methodologies for assessing static spinal stability are limited to specific tissues and could lead to inconclusive results. A three-dimensional finite element model of the spine, with structured analysis of major torso tissues, allows for objective investigation of static spine stability. Methods A novel previously fully validated spine model was employed. Major torso tissues, mainly the muscles, TLF, and IAP were individually, and in combinations, activated under a 350N external spine perturbation. The stability contribution exerted by these tissues, or their ability to restore the spine to the unperturbed position, was assessed in different case-scenarios. Results Individual activations recorded significantly different stability contributions, with the highest being the TLF at 71%. Combined or synergistic activations showed an increase of up to 93% stability contribution when all tissues were simultaneously activated with a corresponding decrease in the tensile load exerted by the tissues themselves. Conclusion This investigation demonstrated torso tissues exhibiting different roles toward static spine stability. The TLF appeared able to dissipate and absorb excessive loads, the muscles acted as antagonistic to external perturbations, and the IAP played a role limiting movement. Furthermore, the different combinations explored suggested an optimized engagement and coordination between different tissues to achieve a specific task, while minimizing individual work.Level of Evidence: N/A.

STUDY DESIGN An experimental design to investigate activation patterns of trunk muscles during multidirectional exertions. OBJECTIVES To evaluate trunk muscle activation patterns in varying directions and moment magnitudes during an isometric task, and to investigate the effects of angle and level of isometric exertion on the electromyography (EMG) variability of trunk muscles in upright posture. SUMMARY OF BACKGROUND DATA Few studies have investigated trunk muscle activation patterns in multidirectional exertions with different moment magnitudes. METHODS A total of 12 asymptomatic male subjects were participated in the study. The EMG activity of 10 selected trunk muscles was collected in the 3 seconds end point matching tasks in 8 angles and 3 magnitudes of exertion. Trunk muscle activation patterns were examined using EMG tuning curves and measuring preferred direction (mean vector direction) and the index of spatial focus. The effect of exertion level on these measures was investigated by Rao test. The effects of angle and level of exertion on the EMG variability of trunk muscles were tested by analysis of variance with repeated measures design. RESULTS No significant difference in EMG tuning curves, preferred direction, and the index of spatial focus was found for each muscle studied across exertion levels (P > 0.05). The index of spatial focus of most muscles studied was not changed with increasing moment magnitude. EMG variability of trunk muscles was significantly affected by angle and level of exertion and their interaction effect (P < 0.001). CONCLUSION Consistent activation patterns of trunk muscles were found within and among subjects in different moment magnitudes. The index of spatial focus indicated that probably no shift to a higher co-contraction strategy has been adapted with increasing moment magnitude. The results suggested that increased EMG variability of trunk muscles in asymmetric exertions may be associated with lower trunk controllability during combined exertions.

Study Design. Systematic review. Objective. To systematically review the literature on the rater reliability of Rehabilitative Ultrasound Imaging (RUSI) measurements to assess the morphology of the abdominal and lumbar trunk musculature. SUMMARY OF BACKGROUND DATA.: RUSI is an increasingly popular method of evaluating the morphology and function of muscles with real-time ultrasound. Conclusions regarding the reliability of measurements obtained by RUSI, need to be established before recommending its wider use. Methods. A systematic approach to searching and identifying original research articles reporting quantitative RUSI measurements was undertaken. Reliability data were extracted and methodologic quality was evaluated by 2 independent reviewers. Results. Of the 24 studies included, 6 were deemed to be of high methodologic quality. Among high quality studies, some reported the measurement error associated with performing repeated measurements of the same image (intraimage analysis), whereas others reported the reliability of obtaining and measuring unique RUSI images (interimage analysis). Intraimage measurements demonstrated good intrarater and interrater reliability (ICC: >0.93). Interimage measurements demonstrated good reliability between raters (ICC: >0.90). Interimage, intrarater correlation coefficients were more variable with ICC values ranging from 0.62 to 0.97. Conclusion. The methodologic quality of research investigating the reliability of RUSI to measure the abdominal and lumbar trunk muscles needs to be improved. The majority of results of high quality studies indicate that RUSI has good levels of rater reliability. Improved reliability was observed among studies examining muscle thickness, and when using mean measurement values obtained by more experienced examiners.

Ultrasound and electromyographic (EMG) measures of trunk muscle activity were compared between low back pain (LBP) and control subjects in a cross-sectional study.To compare the recruitment of the abdominal muscles (measured as a change in thickness with ultrasound imaging) between people with and without low back pain and to compare these measurements with EMG recordings made with intramuscular electrodes.Although ultrasonography has been advocated as a noninvasive measure of abdominal muscle activity, it is not known whether it can provide a valid measure of changes in motor control of the abdominal muscles in LBP.Ten subjects with recurrent LBP and 10 matched controls were tested during isometric low load tasks with their limbs suspended. Changes in thickness from resting baseline values were obtained for transversus abdominis (TrA), obliquus internus (OI), and obliquus externus (OE) using ultrasonography. Fine wire EMG was measured concurrently.Study participants with LBP had a significantly smaller increase in TrA thickness with isometric leg tasks compared with controls. No difference was found between groups for OI or OE. Similar results were found for EMG. People with LBP had less TrA EMG activity with leg tasks, and there was no difference between groups for EMG activity for OI or OE.This study reinforces evidence for changes in automatic control of TrA in people with LBP. Furthermore, the data establish a new test of recruitment of the abdominal muscles in people with LBP. This test presents a feasible noninvasive test of automatic recruitment of the abdominal muscles.

Study Design. Quiet stance on supporting bases with different lengths and with different visual inputs were tested in 24 study participants with chronic low back pain (LBP) and 24 matched control subjects. Objectives. To evaluate postural adjustment strategies and visual dependence associated with LBP. Summary of Background Data. Various studies have identified balance impairments in patients with chronic LBP, with many possible causes suggested. Recent evidence indicates that study participants with LBP have impaired trunk muscle control, which may compromise the control of trunk and hip movement during postural adjustments ( e. g., hip strategy). As balance on a short base emphasizes the utilization of the hip strategy for balance control, we hypothesized that patients with LBP might have difficulties standing on short bases. Methods. Subjects stood on either flat surface or short base with different visual inputs. A task was counted as successful if balance was maintained for 70 seconds during bilateral stance and 30 seconds during unilateral stance. The number of successful tasks, horizontal shear force, and center-of-pressure motion were evaluated. Results. The hip strategy was reduced with increased visual dependence in study participants with LBP. The failure rate was more than 4 times that of the controls in the bilateral standing task on short base with eyes closed. Analysis of center-of-pressure motion also showed that they have inability to initiate and control a hip strategy. Conclusions. The inability to control a hip strategy indicates a deficit of postural control and is hypothesized to result from altered muscle control and proprioceptive impairment.

Trunk muscle strength and the effect of trunk muscle exercises on chronic low back pain were investigated in patients with chronic low back pain.Patients with chronic low back pain include those with organic lumbar lesions and those without such lesions. This study analyzed the differences in trunk muscle strength and effect of trunk muscle exercises between these two groups of patients.Previous studies have reported lower trunk muscle strength in patients with chronic low back pain and higher efficacy of trunk muscle exercises for treating chronic low back pain. However, no analysis have yet been done of differences in these parameters between patients with chronic low back pain with and without organic lumbar lesions.One-hundred-twenty-three patients with chronic low back pain and 126 healthy individuals without low back pain (control group) underwent trunk muscle strength evaluation. The patients were further divided into two groups-- those in group 1 had detectable organic lumbar lesions and those in group 2 had no detectable organic lesions. Seventy-two of these patients performed trunk muscle exercises and the correlation between improvement in low back pain and increase in trunk muscle strength was analyzed.Trunk flexor and extensor strengths were significantly lower in both groups. However, the flexor/extensor ratio of maximum torque was significantly higher in group 1 than in the control group, but was not significantly different between group 2 and the control group. Trunk muscle exercises reduced low back pain in both groups, but were more effective in group 2 than in group 1. The degree of correlation between increase in trunk muscle strength and improvement of low back pain also was higher in group 2 than in group 1.This difference in flexor/extensor ratio may have been due to reduced extensor strength resulting from neurogenic muscle weakness induced by the organic lumbar lesions in group 1. The exercise-associated increase in trunk muscle strength did not completely eliminate the low back pain induced by the organic lumbar lesions in group 1. However, increasing trunk muscle strength was extremely effective in patients of Group 2, in which decreased trunk muscle strength was a major factor in chronic low back pain.

Study design This cohort study examined a sample (n = 152) of subjects tested for isokinetic lumbar strength and endurance, using novel endurance measures. Objectives To validate a new lumbar sagittal isokinetic endurance testing protocol comparing reliability in a normal subject cohort with strength test reliability to include presentation of a gender-specific normative database, and then correlating the results to a Sorenson isometric endurance protocol. Summary of background data The isometric Sorenson test has been virtually the only validated clinical tool for lumbar extensor trunk muscle endurance testing, using an exercise chair and permitting the subject to maintain the trunk horizontal against gravity for a single timed contraction. Alternative isokinetic sagittal lumbar performance measurement methodology has been developed recently to measure trunk muscle endurance by determining declining work performance on repeated, reciprocal dynamic contractions. Method We compared protocols, performance measures, normative data, and reliability for the static isometric Sorenson test to three different isokinetic endurance measurements: the endurance ratio, final fatigue ratio, and recovery ratio. Subjects were tested on a sagittal Cybex TEF (Lumex, Inc., Ronkonkoma, NY) unit for a strength trial followed by an endurance trial. Subgroups also performed reliability and isometric endurance protocols. Results We found an extremely low test-retest correlation for the isometric Sorenson trunk extension test. All test-retest correlations for the corresponding isokinetic endurance measures were significant and markedly higher. Extensor muscle performance declined more substantially on all endurance measures than flexors and showed more variability. In contrast, trunk strength measures were more reliable and less variable than corresponding endurance measures. Moreover, correlations between the isometric Sorenson test and the isokinetic endurance measures were all negative; i.e., increases in Sorenson time are moderately correlated to greater decline in work performance. Conclusions Reliability of the Sorenson isometric endurance test is unacceptably low, showing negative correlations to all isokinetic endurance tests for lumbar extensors. Isokinetic strength and endurance tests are far more reliable than isometric tests, with normative data showing more consistent results from men than women. Both genders display more substantial fatigue (and greater variability) in extensor endurance compared with flexor testing. Endurance measures are identified as human performance cognitive constructs, and reasons for greater variability than usually shown by trunk strength measurements are discussed.

Sudden and unexpected loading to the torso has been reported in the literature as a potential cause of low-back disorders. When such loadings occur, it is hypothesized that the body's response is designed to minimize the destabilizing postural disturbance, and to minimize the mechanical loading of the musculoskeletal system. This study tested hypotheses regarding the role of task experience in the development of preparatory strategies that potentially minimize the postural disturbance to the body and minimize the mechanical loading of the spine. These strategies were hypothesized to consist of muscle pretensioning, postural changes, and intra-abdominal pressure (IAP). Four subjects participated in five to six experimental sessions in which a sudden load was applied by dropping a weight once a minute for 30 minutes. Electromyographic (EMG) data from 10 trunk muscles, IAP data, and postural data were collected during the initial session and final sessions for each subject. The results indicate where each subject developed a unique preparatory strategy. The preparation always involved the pretensioning of the erector spinae muscles, although the coactivation of the other trunk muscles was quite variable across subjects. During the sudden loading the overall postural disturbance was not consistently reduced; however, the trunk flexion was significantly reduced in most subjects. Furthermore, the estimated spinal compression due to muscle loading was significantly reduced in all subjects.

This study aimed to evaluate the lumbar intervertebral discs and the maximum isometric strength and size of the trunk muscles of middle-aged healthy volunteers (60 persons) and low back pain patients (48 persons). Disc degeneration was more frequently seen in the patients than in the healthy volunteers. The psoas and back muscles (erector spinae and multifidus) of the patients were smaller than those of the volunteers. Patients had also more fat deposits in the back muscles than controls. The maximum isometric strength of trunk muscles of the patients was on average weaker than that of the volunteers. However, the size of the back muscles was not related to the maximum isometric extension strength of the trunk.

Trained weight lifters lift heavy loads without a concomitant degree of acute low-back injuries. To study the process by which large loads are lifted with minimal injury, integrated electromyographic signals were recorded from four large muscle groups: gluteus maximus, quadriceps, latissimus dorsi, and erector spinae in 4 weight lifters and 11 asymptomatic control subjects. These signals were recorded during a floor-to-knuckle-height isokinetic lift (dead lift) at 30.5 and 45.7 cm/sec. The signals were normalized for the height of the lift and the maximal isokinetic integrated electromyographic activity. The weight lifters achieved maximal force at 50% of maximal lift height, whereas the control subjects achieved it at 67%. Although not statistically significant, the weight lifters used the gluteus maximus more during the early stages of the lift, perhaps contributing to earlier development of force. This process would stabilize the pelvis and permit the erector spinae to extend the trunk more efficiently. The weight lifter then completed the lift with prolonged and increasing activity in the quadriceps. This technique may minimize the required force in the erector spinae and the forces on the low-back structures. Clinical implications include more effective strength training of lifting muscle groups other than spinal extensors and the teaching of lifting strategies employed by weight lifters in low-back rehabilitation and work-hardening programs.

STUDY DESIGN A cross-sectional study on young adults. OBJECTIVE To evaluate the relationships between low back pain (LBP), maximal isometric trunk muscle strength, and body sway among young adults. SUMMARY OF BACKGROUND DATA The results of previous studies evaluating the association between trunk muscle strength and LBP are conflicting and heterogeneous. Furthermore, there are only few studies on the association between body sway and LBP. METHODS The subjects (n = 874) belonged to a subcohort of the Northern Finland Birth Cohort 1986 (mean age 19 years). Trunk muscle strength and body sway were measured from all subjects. LBP symptoms were inquired with a questionnaire, which was completed concurrently with the examinations. Latent Class Analysis (LCA) was used to cluster the subjects according to their LBP symptoms. RESULTS LCA analysis produced 6 clusters differing with respect to LBP symptoms. There were no statistically significant differences between the clusters in trunk muscle strength or body sway. CONCLUSION LBP does not seem to be associated with maximal isometric trunk muscle strength or body sway in young adults.

Study design A cross-sectional study of the timing of trunk muscle activations between 19 participants with chronic low back pain (LBP) compared with 19 matched controls. Objective To determine the effects of target height and load on trunk muscle coordination in whole body reaching tasks, and whether participants with chronic LBP display a shift in trunk muscle coordination performing these tasks. Summary of background data Changes in the precise timing of trunk muscle activation may cause an initial episode of back pain, or contribute to the development of recurrent or chronic symptoms. However, most paradigms used to examine timing of trunk muscle activation did not necessitate large displacements of the trunk. Methods Participants with and without chronic LBP performed a series of bilateral reaching tasks to 3 target heights with 3 different loads held in the reaching hands. During reaching, joint motions were recorded with an optoelectric system and surface electromyographic signals were collected bilaterally from 5 trunk muscles: rectus abdominis, external oblique, internal oblique, iliocostalis lumborum, and the multifidis, and bilaterally from the deltoid muscle. The onset latencies of the antagonist trunk muscles relative to the deltoid muscle were analyzed to determine the effects of group, target height and load. Results Onset of trunk extensor muscles was significantly delayed in participants with chronic LBP compared with control subjects. Further, the onset latency of the antagonist trunk muscles increased with target distance, but decreased with target load. Conclusion These findings suggest that a well documented control strategy generalizes beyond single joint movements and that individuals with chronic LBP display a shift in this strategy.

Timing of activation of the hamstrings and erector spinae was assessed using surface electromyography.To investigate the influence of posture and movement speed during trunk flexion-extension on the flexion-relaxation response and trunk muscle activation patterns.The literature contains numerous reports on coactivity and synergistic behavior of major muscle groups during trunk flexion-extension. There are few reports on the timing of muscle activation.Six subjects were recruited for a training session and six biweekly test sessions. Ten surface electromyogram electrodes and a lordosimeter were used to record timing of lumbar motion and muscle recruitment in the hamstrings and at four sites in the thoracolumbar region. A 3 x 2 within-subject factorial design was used to test the effects of posture and speed on activation patterns.Patterns of muscle activation were found to be dependent on posture and the direction of movement. The flexion-relaxation response was pervasive in the lumbar region but was less consistent at the T9 and hamstring sites. Significant differences in the delay between electromyogram activation and lumbar motion were found for the standing postures at initiation of extension, in which activation progressed in the caudad-to-cephalad direction.The flexion-relaxation response is ubiquitous in the lumbar erector spinae and is present in the hamstrings and lower thoracic erector spinae, although not consistently in all subjects. In standing, timing of activation differed significantly by site in extension but not in flexion. Muscle activation patterns and flexion-relaxation were consistent over six biweekly test sessions.

Study Design. Serial changes in trunk muscle performance were prospectively studied in 20 patients who underwent posterior lumbar surgery. Objective. To evaluate the influence of back muscle injury on postoperative trunk muscle performance and low back pain, to clarify the significance of minimization of back muscle injury during surgery. of Background Data. The current investigators have reported examination of iatrogenic back muscle injury in an animal model and in humans. However, definite impairment caused by such back muscle injury has not been clarified. Methods. The patients were divided into a short-retraction-time group (

This was a prospective 3-year follow-up study of randomized matched subgroups of 15-year-old school children with or without low back pain initially.In addition to low back pain and leisure time physical activity, spinal mobility, trunk muscle strength, and early degenerative findings of the lumbar spine were evaluated.Reliable epidemiologic studies on the prevalence of low back pain and development of early degenerative changes of the lumbar spine in young persons have been sparse. Along with several other characteristics, the relationship of these changes to frequent low back pain in young persons is not known.After a questionnaire-based survey was administered, subjects with or without low back pain were examined initially and at follow-up with special reference to leisure time physical activity, anthropometry, spinal mobility, trunk muscle strength, and magnetic resonance imaging findings of the lumbar spine.At baseline and at follow-up, those subjects with initial low back pain were characterized by a low frequency of physical activity and decreased spinal function. During follow-up, the occurrence of disc degeneration increased significantly more in the original group with low back pain than among asymptomatic subjects. Furthermore, disc degeneration at baseline significantly predicted future frequent low back pain. Initial disc protrusion also predicted future frequent low back pain.After the rapid physical growth period, there seemed to be a causal relationship between the early evolution of the degenerative processes of the lower lumbar discs and frequent low back pain in several subjects.

Study design Measured trunk muscle activity was employed in a biomechanical model to determine the influence of including or neglecting muscle coactivity on predicted spinal loads. Objectives The purpose of this investigation was to examine the influence of muscle coactivity on spinal load. Summary of background data Electromyographic patterns in the trunk musculature have demonstrated significant levels of cocontraction during lifting exertions. Biomechanical analyses of musculoskeletal loading are often mathematically constrained from including muscle coactivity. Models that attempt to include coactive behavior are complex and difficult to implement. Methods Electromyographic data were collected from five trunk muscle pairs while subjects performed dynamic lifting exertions. A validated, electromyographically assisted biomechanical model was used to compute relative muscle force, lifting moment, and spinal load. Results were generated and compared from analyses that included from one to five simultaneously active muscle pairs. Results Trunk extensor muscles generate lifting moments as much as 47% greater than the applied lifting moment to offset flexor antagonism. Analyses that neglect muscle coactivity during dynamic lifting exertions may underestimate spinal compression by as much as 45% and shear forces by as much as 70%. Conclusions The level of coactive spinal loading is significantly influenced by the weight of the lifted load as well as trunk extension velocity. Muscle coactivity significantly influences the modeled load in the lumbar spine during lifting exertions and should be considered if an accurate measure of spinal loading of desired.

Thirty-one healthy men were tested for the effects of trunk-flexion positions (0 degrees, 15 degrees, and 35 degrees) in standing on triaxial torques and electromyogram of 10 trunk muscles during voluntary maximal and submaximal isometric trunk extension. At a more flexed position, both erector spinae and latissimus dorsi showed significantly higher RMS-EMG. The abdominal obliques were coactivated only during 100% maximum voluntary exertion at each posture. In all tests, the rectus abdomini were quiet. Mean maximum extension torque increased significantly at 15 degrees and 35 degrees of trunk flexion. The ratio of extension torque over RMS-EMG of the trunk extensor muscles, called the neuromuscular efficiency ratio (NMER), also increased in the more flexed posture. However, NMER has to be interpreted with caution because it is affected both by posture and exertion levels. The effects of posture on the torque generation capability of the trunk question the validity of the current lifting recommendations.

An experiment was performed to determine the reaction of the trunk muscles, using electromyography, and intra-abdominal pressure to components of trunk loading commonly seen in the workplace during manual materials handling. These components included angular trunk velocity, trunk position in three-dimensional space and trunk torque exertion level. The experiment was performed using 44 subjects. Subjects produced constant trunk extension torque about the lumbosacral junction while moving the trunk under constant angular velocity (isokinetic) conditions. Significant reactions to trunk angular velocity, trunk torque level, and unique combinations of trunk position and velocity were seen in all muscles of the trunk. The other components affected the muscles selectively according to function. Intra-abdominal pressure only reacted significantly to trunk angle and some unique trunk angle-asymmetry positions. The biomechanical implications of these findings are discussed. The reactions of the muscles to the various workplace components also were described quantitatively through equations that predict muscle activity levels.

The purpose of this investigation was to assess the reliability of isokinetic trunk muscle performance. Sixty-one volunteers participated (29 men, 32 women; age range, 20-60 years). All subjects were without low-back symptoms at the time of testing. All testing was performed with the subject initially standing, using speeds of 60, 120, and 180 degrees per second. Ten repetitions of flexion and extension were performed reciprocally at each speed, with a 3-minute rest period between speeds. Test-retest intervals were 1 and 3 weeks from the initial test. Peak torque-to-body-weight ratios, extension-to-flexion ratios, and average work per repetition were calculated for each speed for flexion and extension. Data were analyzed with analysis of variance, intraclass correlation coefficients, and Pearson correlation coefficients. Intraclass correlation coefficient values ranged from .74 to .88 for measurements derived from peak torque, and from .88-.93 for measurements derived from work (with the exception of .69 for men at 180 degrees/sec). Standard error of measurements ranged from 8 to 32 ft-lb, with a tendency to increase with increasing speeds. It was concluded that, when using this protocol, isokinetic measurements of muscle function offer the clinician sensitive and reliable measurements of trunk muscle performance and that incorporating increased practice with women and longer rest periods with men may further decrease error associated with these isokinetic trunk strength measurements.

The orientations and moment arms of nine trunk muscles: latissimus dorsi, iliocostalis, longissimus dorsi, obliquii, rectus and transversalis abdominis, quadratus lumborum, and iliopsoas were obtained on embalmed specimens. Each muscle was considered as one or several, linear or curvilinear, lines of action. Origins, insertions, and points along the length of main bundles were digitized for each muscle using a three-dimensional digitizer. The results obtained from seven male specimens are presented and will permit more refined biomechanical models.

The lack of trunk muscle strength and endurance has frequently been cited as a suspected factor in the etiology of low-back pain. Several investigators have suggested that asymptomatic patients have stronger trunk muscles than patients with low-back pain. People who are physically fit appear to have a decreased incidence of low-back pain. Increased trunk muscle endurance also have been observed to decrease the incidence of low-back pain. The objective evaluation of the strength and endurance of trunk musculature may, therefore, be significant. Part 1 of this study was designed to develop a reproducible strength-endurance screening procedure and to establish normal isometric-isokinetic trunk muscle strength and endurance parameters for women. This study showed that isometric trunk flexion varied from 19-109 Nm and trunk extension from 38-168 Nm. Peak values for isokinetic trunk flexion at two speeds (30 degrees per second and 60 degrees per second) varied from 17-191 Nm and isokinetic trunk extension from 14-208 Nm. The average endurance time for trunk extensors tested with the Sorensen test was 196 seconds.

Ten subjects executed a number of weight-holding and force-resisting work tasks while standing either upright or with their trunks in 30 degrees of forward flexion. All tasks involved sagitally symmetric body configurations and were performed isometrically. A simple calculation scheme was devised to predict the lumbar trunk muscle contraction forces and the lumbar spine compression forces required for execution of each task. The myoelectric activity was recorded quantitatively at eight sites over the lumbar trunk muscles and at four sites over the abdominal muscles. Good correlation was found between the predicted muscle contraction forces and the myoelectric activities.

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.

A new method of quantitative measurement with a cybex machine is applied to the trunk muscles. The curves of muscle torque and muscle fatigue are easily obtained in clinical medicine. In normal controls, maximal muscle torque is greater in back muscles than in abdominal muscles, and the definite influence of aging is found in both muscles. Furthermore, the trunk muscles are more easily fatigued by a sustained contraction than by repeated contractions, and abdominal muscles are more easily fatigued than back muscles. The role of the trunk muscles in the mechanism of pain production and prevention is still to be determined.

Ten male and ten female subjects were tested for their ability to exert maximal force about the lumbo-sacral junction (as is done during lifting) under controlled isometric and isokinetic conditions. The myoelectric activity of ten trunk muscles, intra-abdominal pressure, and torque produced by the back were monitored. There are prominent differences in the manner in which subjects utilize the musculature of the trunk for the production of torque statically and dynamically. A significant lag was identified between the onset of intra-abdominal pressure and torque, and this lag increased with increasing trunk velocity. These differences between isometric and isokinetic exertions suggest that isokinetic trunk testing provides a means of controlled evaluation that is appropriate for manual materials handling situations.

This report reviews data obtained from electromyographic studies of the musculature of the trunk and considers their physiologic and methodologic bases. Current knowledge regarding the relation between electrical and mechanical output of muscle is incomplete and conflicting, but supports interpreting electromyographic information based on a principle of monotonicity, in which changes in electrical output parallel changes in force. Electromyographic information is utilized to define the role of individual trunk muscle groups in the functional anatomy of the lumbar spine in various positions, motions, and conditions.

An investigation of the absolute strength of the human muscle was carried out on the in vivo erector spinae muscle using magnetic resonance tomography coupled with dynamic muscular testing. The absolute strength of the erector spinae was calculated to be 48 N/cm2. The area of the rectus abdominis was 15.1 cm2, and the area of the erector spinae was 54.5 cm2. The internal moment arm for the rectus abdominis and erector spinae muscles was 7.04 and 5.64 cm, respectively. The static force measures showed the trunk extensor moment to be only 30% greater than the flexor moment. The difference is discussed in terms of the absolute strength of muscle, and other anatomic factors.

An objective method was used to evaluate the validity of the sit-up, prone trunk extension, and double leg lowering clinical tests. Normal men and women and patients with a history of backache served as subjects. The vast majority of the subjects were able to perform the Grade 1 level, which was the highest resistance imposed by the sit-up and prone extension tests. The double leg lower was superior to the other two clinical tests but was able to identify only broad differences in strength capability. In the main, the subjective clinical tests were poor discriminators and seemed to lack the range of resistance necessary to be definitively useful as methods of assessing trunk muscle strength and may not provide appropriate resistance for improving trunk muscle strength in most patients.

There are two theories as to why bracing may prevent the progression of idiopathic scoliosis curves, the passive and the active theories. The passive theory is that progression is prevented by the forces exerted by the brace. The active theory is that progression is prevented by muscle contractions that arise in response to wearing the brace. This study examined the active theory of brace correction. Trunk muscle myoelectric activities were measured in ten adolescent females with right thoracic idiopathic scoliosis being treated with Boston braces. Activities were both measured when wearing and when not wearing their braces. Differences in braced and unbraced myoelectric activities were seldom statistically significant and never biomechanically significant. Boston brace effectiveness seems not to result from active responses to brace wearing.

Twenty laborers assumed specific lumbar spine postures and lifted a 157 N crate to three different hand heights to determine if lumbar spine flexion moments or trunk muscle activity were affected by the lifting postures. Lumbar flexion moments were lowest when the workers used the lordotic and straight back postures, while the average erector spinae muscle activity tended to be highest in the lordotic and straight back postures. The kypohotic posture regularly reduced the activity of the erector spinae to bursts of activity while lifting and caused more discomfort during the lifting tasks than any other posture. Therefore, the lumbar lordotic posture is recommended as the posture of choice while lifting, particularly when lifting from the floor level.

The purpose of this study is to identify those individuals at risk who have weak trunk muscles and are prone to back pain. The overall thrust of this research is to develop a quantitative method to assess dynamic strength of the trunk muscles. Two unique isokinetic strength testing units in sitting and standing postures have been designed. Three groups of volunteers were tested at different times and places. Quantitative measurements of the maximum strength, fatigue behavior of the abdominal and paraspinal muscles, maximum strength in different age groups and the role of the iliopsoas muscle have been performed. The study shows that women have lower maximum strength but equal or better fatigue endurance than men. There is a significant change in maximum strength with age. The maximum abdominal strength change with age showed a bimodal distribution. The iliopsoas muscle approximately doubled the maximum back strength in flexion. The test in the sitting posture was tolerated better than the test in the standing posture. Isokinetic back strength testing in the sitting posture was found to be effective and safe.

In this paper, the authors present a deterministic simulation model, which they call Simulift, of trunk-muscle activity and intra-abdominal pressure during a sagittally symmetric trunk exertion. Simulift is a descriptive model that quantifies the time-varying loading of the spine based on observed internal forces. Recent findings about the time sequence of events during trunk motion and established equilibrium formulas provide the theoretical bases for the simulation. A profile of electromyographic activity in ten trunk muscles and intra-abdominal pressure is updated as simulated time passes, or as the trunk motion is simulated. Input to the model includes a list of motion-event times and a set of profile-component-behavior data. Simulift is an "impulse" model that computes instantaneous and time-integrated statistics on individual muscle activity, intra-abdominal pressure, compression, lateral shear, and anterior shear as the profile components of the simulated subject change. Computer results for the simulation model are presented.

Quantitative theoretical analyses of the ability of trunk muscle contraction forces to reduce lateral curves in the spine are presented. The effects of contraction of each of 68 muscle slips on each of 13 configurations of scoliosis were examined using biomechanical models of the trunk. The lateral curve, sagittal curve, and longitudinal axis rotation changes that resulted from contraction of these muscles were determined in each case. The muscles best able, from a biomechanical viewpoint, to reduce different lateral curves are listed. Effects of initial postural configurations and the consequences of reflex attempts to right the trunk after contracting a trunk muscle are described. Substantial changes in spine configuration can result from trunk muscle contractions of even modest intensity.

The prediction of five internal muscle variables extracted from computed tomography scans was attempted using 27 anthropometric variables. Stable regression equations are presented for the prediction of the cross-sectional area of the rectus abdominis, psoas, and erector spinae, as well as for the moment arm of the erector spinae. No stable regression equation was found for the prediction of the moment arm of the rectus abdominis, and the results indicated that the method was group dependent. These findings have implications for human modeling studies that use estimated parameters for the internal muscle variables.

Intra-abdominal pressure measurements correlate with intradiscal pressures and myoelectric activity of the trunk muscles and are useful determinants of spinal stress. Measurements made in industrial situations using a radio pill allow analysis of stresses imposed by different tasks.

Several studies have shown positive correlations between muscle strength, flexibility, and the frequency of low-back pain. Weak trunk musculature and decreased endurance have thereby come to be identified as significant risk factors in the development of occupational back problems. Because it is widely accepted that exercise plays an important role in the conservative treatment and prevention of low-back pain, the goals of most rehabilitative programs involves improving the strength and endurance of the low-back pain patient. Whereas electrical stimulation has been shown to increase the muscle strength of the lower extremities, this effect has not been demonstrated for the trunk muscles. Part 2 is a prospective controlled study designed to document and to compare objectively the effects of electrical stimulation and exercise on trunk muscle strength. A total of 117 healthy women were divided randomly into four groups. Two groups received electrical stimulation with different electrical parameters, one group received exercises, and one group acted as a control group. The results showed that low-frequency electrical stimulation and exercises significantly (P less than .05) increased isokinetic back-muscle strength compared to the control and medium-high-frequency electrical stimulation groups. Both types of electrical stimulation, however, significantly increased (P less than .05) the endurance in the back muscles compared with the control and the exercise groups. This study showed that electrical stimulation may be a valuable treatment in the early care of low-back pain patients in maintaining and increasing strength and endurance of back muscles when a more active exercise program is too painful to perform.

The effects of wearing commonly prescribed low-back braces and corsets on restriction of gross body motions were investigated. A lumbosacral corset, a chairback brace, and a molded plastic thoracolumbosacral orthosis (TLSO) were studied. Four trunk movements (flexion, extension, lateral bending, and twisting) were examined in five healthy adult men when standing and sitting. All three orthoses restricted at least some gross body motion to approximately two thirds to one half of no-orthosis values. All three orthoses failed to provide restrictions of at least 10% in at least one motion. Mean motion restriction across all eight movements studied in all five subjects were largest when wearing the TLSO and least when wearing the corset. Gross body motion restrictions relieve lumbar trunk muscle and spine loads.

This paper presents procedures to calculate the loads on the lumbar spine and the contraction forces in the trunk muscles that are likely to be produced by given physical activities.

A quantitative study of the trunk muscle strength and fatigability was performed using an isokinetic dynamometer to determine the role of trunk muscles in the low-back-pain syndrome and in particular to investigate the correlation of trunk muscle strength and lumbar lordosis. Most patients demonstrated a generalized weakness of the trunk muscles. The trunk muscle strength of patients suffering from backache for less than one month was significantly lower than that of the controls. The strength of the trunk muscles was not influenced by the duration of symptoms. There was no imbalance between the trunk flexors and extensors. The patients with back pain had a greater fatigability of the trunk flexors than the controls. There was negative correlation between the trunk muscle strength or fatigue and lumbar lordosis.

The myoelectric activity of selected trunk muscles was recorded during the development of controlled isometric axial torques. Muscle activity was measured bilaterally over the erector spinae, the rectus abdominus, the oblique external and the oblique internal abdominal muscles at the L3 level. Subjects first applied graded isometric torque efforts over a 10 second ramp up to maximum voluntary contraction with the trunk in neutral rotation. They then repeated the effort with the trunk twisted to the left and right. The largest electromyographic activities were found in the agonistic oblique muscles, but considerable antagonistic activity was present also. While the activity of the internal oblique and rectus were bilaterally similar in symmetric standing a difference occurred between the two sides when the trunk was twisted to the right or left. Axial prerotation of the trunk by 30 degrees in the direction of torque development marginally decreased the maximal developed torque, whereas prerotation in the opposite direction increased the developed torque.

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.