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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.

OBJECTIVE Pelvic tilt exercises are used clinically to correct lumbopelvic alignment. The anterior and posterior layers of the quadratus lumborum are important for pelvic motor control in the coronal plane. This study aimed to evaluate whether the anterior and posterior activity is related to the pelvic tilt angle during pelvic tilt exercises. DESIGN The study design was single-occasion repeated measures in a randomized manner. Twelve healthy men performed the four directions of the pelvic tilt exercises (anterior or posterior pelvic tilt and lateral pelvic elevation on the ipsilateral or contralateral measurement side). The electromyographies of the anterior and posterior were recorded using intramuscular fine-wire electrodes and normalized to isometric peak electromyography. RESULTS The activity of the anterior and posterior during lateral pelvic elevation on the ipsilateral measurement side (19.0 ± 16.0 percent of maximal voluntary isometric contraction) was significantly higher than that during other directions of the pelvic tilt exercises (P < 0.01). There was a significant positive correlation between the anterior activity and the maximum change angles of pelvic tilt during lateral pelvic elevation on the ipsilateral measurement side (r = 0.674, P = 0.016). CONCLUSIONS The anterior activity was related to a large lateral pelvic elevation angle on the ipsilateral side during pelvic tilt exercises.

Pitching technique is one of many factors that affect injury risk. Exhibiting excessive contralateral trunk tilt (CLT) during pitching has been linked to higher ball speed but also to increased joint loading. Deficit in trunk muscle strength has been suggested as an underlying cause of this movement pattern. The purpose of the study was to compare trunk muscle strength between youth baseball pitchers with varying degree of CLT during pitching.Cross-sectional study.Baseball practice fields.Twenty-eight youth baseball pitchers.Pitching technique was captured using a video camera. Based on the 2-dimensional trunk contralateral flexion angle, pitchers were categorized into low (15 degrees), moderate (15-30 degrees), or high (30 degrees) CLT groups.Maximum isometric strength tests for trunk flexion, extension, and bilateral rotation, measured using a dynamometer.The pitchers with high CLT (n = 10) had longer pitching experience (P = 0.014), produced higher ball speed (P = 0.003) compared with the pitchers with moderate (n = 10) and low (n = 8) CLT, but demonstrated greater asymmetry in trunk rotation strength (relative weakness in rotation strength toward dominant side) compared with the pitchers with low CLT (P = 0.015).Excessive CLT may be a strategy that young pitchers learn to achieve higher ball velocity but also may be associated with imbalance between the oblique muscles on dominant and nondominant side, which may be acquired from repetitive pitching. Strengthening and emphasizing the use of dominant side oblique muscles may keep pitchers from leaning excessively during pitching and thus decrease joint loading.

A retrospective study.To investigate the relationship between trunk muscle cross-sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion using pedicle screw fixation (PLIF-PSF).Although trunk muscles of the lumbar spine contribute to spinal stability and alignment, effect of trunk muscles on spinal fusion rate and time to fusion is unclear.A total of 192 adult patients with degenerative lumbar disease who underwent PLIF-PSF at L3-L4 or L4-L5 were included. The MCSA of the flexor (psoas major, PS), extensor (erector spinae, ES; multifidus, MF) were measured using preoperative lumbar magnetic resonance imaging at 3 segments. Bone union was evaluated using lumbar dynamic plain radiography. Patients were divided into 2 groups according to the presence of bone fusion.Most PS MCSAs in the fusion group were significantly larger than in the nonfusion group, except for MCSA at the L2-L3 segment (all P0.05). In cases of ES and MF MCSAs, 4 of 6 segments were significantly large. Multivariate analysis revealed that the PS MCSA at L4-L5 was an independent factor for decreased possibility of nonfusion status in both segments (OR=0.812, P=0.028). Pearson analysis demonstrated that the most trunk MCSAs were negatively correlated with time to fusion for both segments and PS MCSAs exhibited a significant correlation with time to fusion except for MCSA at the L2-L3 segment.Trunk MCSAs were significantly larger for a fusion group than a nonfusion group. As trunk MCSAs increased, fusion timing decreased.

The aims of this study were (1) to identify differences in trunk muscle strength and balance among various classes of wheelchair basketball (WCB) players and (2) to determine if trunk muscle strength and balance correlate with the current observation-based classification of WCB players.Isometric trunk strength and balance (limits of stability) were objectively quantified in 42 male WCB players. Principal component analysis was used to synthesize a battery of strength and balance measures into a single, composite score of trunk function. The K-means clustering algorithm was then used to generate an objective classification system by stratifying players into 4 classes based on their trunk function.Results indicated that there were significant differences in trunk muscle strength and balance between various classes of WCB players (P0.05), such that the mean peak trunk extensor and flexor torque and limits of stability indices increased progressively according to the players' classes. There was also a significant correlation between observation-based WCB classification and principal component analysis cluster analysis-based WCB classification (ρ = 0.785, P0.05).This study provides novel evidence indicating that trunk strength and balance differ among various classes of WCB players, and objective measures of trunk function correlate positively with the current observation-based WCB classification system.

The aim of the study was to assess whether hepatic steatosis predicts muscle fat content independent of body mass index (BMI).Regions of interest were drawn over several trunk muscles and over the right lobe of the liver to obtain the computed tomography (CT) density in 100 subjects with unenhanced CT studies of the abdomen and pelvis. Univariate and multivariate linear regression were used to examine the associations between BMI and hepatic steatosis and between BMI and trunk muscle density.Body mass index was associated with trunk muscle fat (P0.05) and hepatic steatosis (P0.05). Computed tomography density of the liver correlated with that of each trunk muscle (P0.05). After adjusting for age, sex, and BMI, hepatic steatosis was associated with increased trunk muscle fat content in the psoas only.The association between muscle fat in most trunk muscles and hepatic steatosis is due to underlying BMI. However, hepatic steatosis predicted psoas muscle fat content independent of BMI (P0.05).

The back squat is a traditional resistance training exercise, whereas the resisted sled exercise is a relatively new resistance exercise. However, as there are no studies comparing muscle activation between the exercises, the objective of this study was to examine activity of leg and trunk muscles for both exercises. Ten healthy resistance-trained men participated in a randomized crossover design study consisting of 2 preparation sessions and 2 testing sessions. Electromyographic (EMG) activity of the rectus femoris, biceps femoris, gastrocnemius, lower erector spinae, and the transversus abdominis/internal obliques (TrA/IO) were monitored during a 20-step maximum push with the weighted sled apparatus and a 10 repetition maximum with a bilateral back squat. There were nonsignificant trends for the rectus femoris (p = 0.092: 8.6-16.7%) and biceps femoris (p = 0.09: 10.5-32.8%) to demonstrate higher activity with the sled and squat exercises, respectively. There were main effects for condition with 61.2% greater gastrocnemius EMG with the sled exercise (p = 0.01) and 74.5% greater erector spinae EMG activity with the squat (p = 0.002). There were no significant differences between the exercises for the TrA/IO. In summary, the sled and squat exercises provided similar EMG activity for the quadriceps, hamstrings, and TrA/IO. The squat provided higher lower erector spinae activation, whereas the sled had superior gastrocnemius activation. Depending on the movement-training specificity of the sport, either exercise may be used in a training program while acknowledging the differences in gastrocnemius and erector spinae activity.

The purpose of this study was to assess the effects of adding elastic bands to free-weight squats on the neuromuscular activation of core muscles. Twenty-five resistance trained women with 4.6 ± 2.1 years of resistance training experience participated in the study. In randomized order, the participants performed 6 repetition maximum in free-weight squats, with and without elastic bands (i.e., matched relative intensity between exercises). During free-weight squats with elastic bands, some of the free weights were replaced with 2 elastic bands attached to the lowest part of the squat rack. Surface electromyography (EMG) activity was measured from the erector spinae, external oblique, and rectus abdominis, whereas a linear encoder measured the vertical displacement. The EMG activities were compared between the 2 lifting modalities for the whole repetition and separately for the eccentric, concentric, and upper and lower eccentric and concentric phases. In the upper (greatest stretch of the elastic band), middle, and lower positions in squats with elastic bands, the resistance values were approximately 117, 105, and 93% of the free weight-only trial. Similar EMG activities were observed for the 2 lifting modalities for the erector spinae (p = 0.112-0.782), external oblique (p = 0.225-0.977), and rectus abdominis (p = 0.315-0.729) in all analyzed phases. In conclusion, there were no effects on the muscle activity of trunk muscles of substituting some resistance from free weights with elastic bands in the free-weight squat.

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.

The purpose of this study was to compare the electromyogram (EMG) activity of the trunk musculature for long throwers and short throwers during the side medicine-ball throw. The study consisted of 2 sessions. Thirty athletes performed the side medicine-ball throw (S-MBT) in the first session. The top 5 subjects (long throwers) and the worst 5 subjects (short throwers) in the performance of the S-MBT proceeded to the second session. These subjects performed the fast side medicine-ball throw (FS-MBT) and the isometric maximal trunk rotation torque (IMTRT) test after applying surface electrodes bilaterally to the following muscles: pectoralis major, rectus abdominis, external oblique, and latissimus dorsi. The value of IMTRT in the left turn in long throwers was significantly greater (p < 0.05) than that recorded for short throwers, whereas no difference was observed in the right turn. The velocities of the medicine ball using 2-kg, 4-kg, and 6-kg medicine balls were significantly different (p < 0.01-0.001) between long throwers and short throwers The examination of EMG activity in each muscle group for long throwers and short throwers revealed that the major difference between the 2 groups is EMG activity of the left external oblique. These results suggest that the EMG activity of the external oblique on either side is an important factor for FS-MBT.

Although exercise speed is an acute variable to prescribe abdominal strengthening programs, current literature lacks studies analyzing the influence of speed on muscular activation in abdominal exercises. The aim of this work was to determine the influence of trunk curl-up speed on the amplitude of muscular activation and the way in which the trunk muscles were coactivated. Twenty recreationally trained volunteers (16 women and 4 men; age, 23.7 +/- 4.3 years; height, 166.2 +/- 6.3 cm; mass, 61.0 +/- 8.2 kg) participated in this study. Surface electromyographic data were collected from the rectus abdominis, external oblique, internal oblique, and erector spinae during 4 different curl-up cadences [1 repetition per 4 seconds (C4), 1 repetition per 2 seconds (C2), 1 repetition per 1.5 seconds (C1.5), 1 repetition per 1 second (C1)], and during maximum speed curl-ups (Cmax). The electromyographic amplitude was averaged and normalized using maximum voluntary isometric contractions (MVICs). Statistical analyses were performed using repeated-analyses of variance. Normalized electromyographic mean amplitudes of trunk muscles increased with curl-up speed. Although the rectus abdominis (ranged from 23.3% of MVICs at C4 to 49.6% of MVICs at Cmax) and internal oblique (ranged from 19.2% of MVICs at C4 to 48.5% of MVICs at Cmax) were the most active analyzed muscles at each speed, contribution of the external oblique increased appreciably with velocity (ranged from 5.3% of MVICs at C4 to 33.3% of MVICs at Cmax). Increasing trunk curl-up speed supposed greater trunk muscular coactivation, probably required for a faster performance and to ensure dynamic spine stability. On the basis of our findings, curl-up speed had an important effect on trunk muscular recruitment and must be taken into account when prescribing exercise programs for abdominal conditioning.

The purpose of this study was to examine the repeatability and reproducibility of the different tests of a clinical test battery evaluating the components of functional spinal stability: postural control (sway velocity data), proprioception (repositioning error), and muscle activation (electromyographic data).A total of 28 healthy volunteers participated in this study: 14 in the repeatability study and 14 in the reproducibility study. Each subject was tested three times, with an interval of 1 wk between the test sessions. The intraclass correlation coefficients and the standard error of the measurements as a percentage of the grand mean were calculated.The intraclass correlation coefficients for both the repeatability and the reproducibility evaluation showed good to excellent reliability for all variables (intraclass correlation coefficient, 0.60-0.98). The standard error of the measurements as a percentage of the grand mean ranged from 0.004 to 19.94.The functional clinical test battery investigated in this study proved to be a reliable tool in the assessment of healthy subjects. The evaluation of postural control, proprioception, and muscle activity (coordination, stabilization, maximal voluntary isometric contraction, endurance, and flexion-relaxation) showed good to excellent repeatability and reproducibility. Further analysis of the reliability of these variables in a clinical setting, particularly in patients with low back pain, seems appropriate.

The purpose of this cross-sectional study was to evaluate the effect of unstable and unilateral resistance exercises on trunk muscle activation. Eleven subjects (6 men and 5 women) between 20 and 45 years of age participated. Six trunk exercises, as well as unilateral and bilateral shoulder and chest presses against resistance, were performed on stable (bench) and unstable (Swiss ball) bases. Electromyographic activity of the upper lumbar, lumbosacral erector spinae, and lower-abdominal muscles were monitored. Instability generated greater activation of the lower-abdominal stabilizer musculature (27.9%) with the trunk exercises and all trunk stabilizers (37.7�54.3%) with the chest press. There was no effect of instability on the shoulder press. Unilateral shoulder press produced greater activation of the back stabilizers, and unilateral chest press resulted in higher activation of all trunk stabilizers, when compared with bilateral presses. Regardless of stability, the superman exercise was the most effective trunk-stabilizer exercise for back-stabilizer activation, whereas the side bridge was the optimal exercise for lower-abdominal muscle activation. Thus, the most effective means for trunk strengthening should involve back or abdominal exercises with unstable bases. Furthermore, trunk strengthening can also occur when performing resistance exercises for the limbs, if the exercises are performed unilaterally.

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.

To evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group.This prospective case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers. The Berg balance scale was used to assess balance and stability, and the FIM instrument was used to evaluate functional disability in the patient group. Patients were evaluated as soon as they were able to stand long enough for testing.Peak torque values for trunk flexion and extension were lower in the stroke patients than in the controls. The differences were significant for trunk flexion and for trunk extension. In both groups, peak torque values for trunk flexors were greater than peak torque values for trunk extensors. There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge. Trunk muscle strength was not correlated with FIM total score or FIM motor score, but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values, except for isometric extension.The findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients, which can interfere with balance, stability, and functional disability.

OBJECTIVE To determine the intrarater and interrater reliability of reciprocal concentric trunk flexion and extension peak torque values at different angular velocities using the Cybex NORM isokinetic dynamometer. DESIGN Trunk flexor and extensor muscles of 15 healthy subjects were assessed at 60 degrees/sec and 90 degrees/sec angular velocities. Each subject was tested by two physicians three times, with at least 48 hr between test sessions. Intraclass correlation coefficients were used to determine the intrarater and interrater reliability of the reciprocal concentric trunk flexion and extension peak torques at 60 degrees/sec and 90 degrees/sec angular velocities. RESULTS For intrarater reliability intraclass correlation coefficients for trunk flexion, peak torque values ranged from 0.89 to 0.95; for the extensors, values ranged from 0.80 to 0.92. The intraclass correlation coefficient values for interrater reliability were also found to be highly reliable, and peak torque values demonstrated intraclass correlation coefficients values that ranged from 0.95 to 0.98. CONCLUSIONS Reciprocal concentric trunk flexion and extension peak torque measurements at 60 degrees/sec and 90 degrees/sec angular velocities had a high intrarater and interrater reliability with the Cybex NORM isokinetic dynamometer in healthy subjects.

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.

The purpose of this study was to examine the extent of activation in various trunk muscles during dynamic weight-training and isometric instability exercises. Sixteen subjects performed squats and deadlifts with 80% 1 repetition maximum (1RM), as well as with body weight as resistance and 2 unstable calisthenic-type exercises (superman and sidebridge). Electromyographic (EMG) activity was measured from the lower abdominals (LA), external obliques (EO), upper lumbar erector spinae (ULES), and lumbar-sacral erector spinae (LSES) muscle groups. Results indicated that the LSES EMG activity during the 80% 1RM squat significantly exceeded 80% 1RM deadlift LSES EMG activity by 34.5%. The LSES EMG activity of the 80% 1RM squat also exceeded the body weight squat, deadlift, superman, and sidebridge by 56, 56.6, 65.5, and 53.1%, respectively. The 80% 1RM deadlift ULES EMG activity significantly exceeded the 80% 1RM squat exercise by 12.9%. In addition, the 80% 1RM deadlift ULES EMG activity also exceeded the body weight squat, deadlift, superman, and sidebridge exercises by 66.7, 65.5, 69.3, and 68.6%, respectively. There were no significant changes in EO or LA activity. Therefore, the augmented activity of the LSES and ULES during 80% 1RM squat and deadlift resistance exercises exceeded the activation levels achieved with the same exercises performed with body weight and selected instability exercises. Individuals performing upright, resisted, dynamic exercises can achieve high trunk muscle activation and thus may not need to add instability device exercises to augment core stability training.

Objective: To evaluate trunk muscle strength and performance in long-term survivors of childhood malignancies relative to age and sex-matched controls, and to relate the muscle strength observations to the therapeutic agents used and possible hormonal disturbances. Design: Age and sex-matched cohort study. Setting: Referral center in the northern part of Finland. Patients: Forty-six long-term survivors of childhood cancer. Mean age at examination 19.1 years and median off-therapy time 9.4 years. Intervention: Isokinetic dynamometer testing. Main Outcome Measures: Measurements of trunk muscle peak torque (PT) and total work done (TWD) were performed at angle speeds of 50°/sec and 200°/sec. The results were normalized relative to body fat-free weight (FFW). Results: PT in the trunk muscles was lower in the patients at both angle speeds (mean normalized PT=5.7Nm/kg FFW vs 7.6Nm/kg FFW for controls at 50°/sec), as also was TWD except for extension TWD at the higher angle speed (mean normalized TWD=59.9J/kg FFW vs 84.6J/kg FFW for controls at 200°/sec). The normalized PT at 50°/sec and TWD at 200°/sec were lower in the males with testicular damage; also, low age at diagnosis correlated positively with muscle strength and performance. There were no differences in normalized PTs or TWDs between cranial radiation and non-radiation cases, or between growth-hormone-deficient and non-deficient cases, and the patients without cranial radiation or with normal growth hormone secretion still had lower normalized PTs and TWDs than the controls. Conclusions: Survivors of childhood malignancies have decreased maximal trunk muscle strength and performance. The etiology of this effect remains unclear, but young age at diagnosis, as well as serum testosterone levels in male survivors, evidently influence muscle strength and performance.

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.

Crawling is one of the most common modes of ambulating in children with severe paralysis and deformities in poliomyelitis. Restoring upright posture and bipedal gait, although desirable, has its own limitations due to various factors. Fifty-three children below the age of 12 years (29 boys and 24 girls) crawling due to post-poliomyelitis residual paralysis were assessed for the genesis of crawling as a mode of ambulating. The patterns of crawling were classified according to Cross's classification. Paralyzed muscles and deformities in definite combinations were found responsible for each type of crawling. Trunk muscles, gluteus maximus, quadriceps, hamstrings, tibialis anterior, and triceps surae were identified as muscles crucial for walking in order of priority. At least antigravity power in these muscles was necessary for an upright posture and walking with support. Various combinations of treatment modalities were used to correct the deformities before fitting an orthosis and instituting gait training. Thirty-four children became outdoor walkers, 14 indoor walkers, and five remained nonwalkers. The most favorable patterns of crawling for restoration of upright posture were true quadruped progression (30 cases) and infant-like crawl (14 cases). Average follow-up was 17 months (range, 6 months to 5 years).