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Recent studies have shown that the extramuscular connective tissue (ECT) is thickened and stiffened in delayed onset muscle soreness (DOMS). However, contrarily to the normal population, severe DOMS is rare in athletes or highly trained individuals. The present randomized, controlled trial therefore aimed to investigate pain as well as microcirculation and stiffness of the ECT and the erector spinae muscle following submaximal eccentric trunk extension exercise not causing DOMS. The effect of manual treatment by a therapist (myofascial release; MFR) on these parameters was to be studied. Trained healthy participants (n = 21; 31.3 ± 9.6 years; > 4 h exercise per week) performed submaximal eccentric exercise of the trunk extensors. One group was manually treated (n = 11), while the other group (n = 10) received placebo treatment with sham laser therapy. Stiffness of the ECT and the erector spinae muscle (shear wave elastography), microcirculation (white light and laser Doppler spectroscopy), palpation pain (100 mm visual analogue scale, VAS) and pressure pain threshold (indentometry, PPT) were assessed before (t 0 ), 24 h (t 24 ) and 48 h (t 48 ) after conditions. Erector spinae muscle stiffness increased after eccentric exercise from t 0 to t 24 (0.875 m/s) and from t 0 to t 48 (0.869 m/s). After MFR, erector spinae muscle stiffness decreased in contrast to placebo treatment at t 24 (-0.66 m/s), while ECT stiffness remained unchanged. Oxygen saturation increased (17-20.93%) and relative haemoglobin decreased (-9.1 - -12.76 AU) after eccentric exercise and MFR differed from placebo treatment at t 48 (-3.71 AU). PPT differed after MFR from placebo treatment at t 48 (20.69 N/mm), while VAS remained unchanged. Multiple linear regression showed that ECT stiffness and group membership predicted erector spinae muscle stiffness. MFR could have a positive effect on pain, microcirculation and muscle stiffness after submaximal eccentric exercise, suggesting better recovery, which needs to be confirmed by future work., (© Journal of Sports Science and Medicine.)

Introduction: The purpose of our report was to use a Random Forest classification approach to predict the association between transcutaneous electrical nerve stimulation (TENS) and walking kinematics at the stride level when middle-aged and older adults performed the 6-min test of walking endurance., Methods: Data from 41 participants (aged 64.6 ± 9.7 yr) acquired in two previously published studies were analyzed with a Random Forest algorithm that focused on upper and lower limb, lumbar, and trunk kinematics. The four most predictive kinematic features were identified and utilized in separate models to distinguish between three walking conditions: burst TENS, continuous TENS, and control. SHAP analysis and linear mixed models were used to characterize the differences among these conditions., Results: Modulation of four key kinematic features-toe-out angle, toe-off angle, and lumbar range of motion (ROM) in coronal and sagittal planes-accurately predicted walking conditions for the burst (82% accuracy) and continuous (77% accuracy) TENS conditions compared with control. Linear mixed models detected a significant difference in lumbar sagittal ROM between the TENS conditions. SHAP analysis revealed that burst TENS was positively associated with greater lumbar coronal ROM, smaller toe-off angle, and less lumbar sagittal ROM. Conversely, continuous TENS was associated with less lumbar coronal ROM and greater lumbar sagittal ROM., Conclusions: Our approach identified four kinematic features at the stride level that could distinguish between the three walking conditions. These distinctions were not evident in average values across strides., (Copyright © 2024 by the American College of Sports Medicine.)

Objective: This study investigates the potential for stress shielding within musculoskeletal soft tissues through analysis of stress distributions between lumbar fascial and muscle tissues via mechanical testing., Methods: Using a custom apparatus, 51 posterior thoracolumbar fascia (TLF) samples and 18 erector spinae (ES) cadaveric samples underwent tensile testing involving three loading-unloading cycles, followed by loading to 6% strain, to mechanically characterize samples. Parallel tensile testing using 20 pairs of two TLF samples, and seven pairs of TLF and ES samples was then conducted for stress distribution analysis between tissues. P<0.05 was deemed significant., Results: The TLF and ES exhibited an average elastic modulus of 150.9 MPa and 0.69 MPa, respectively. At 6% strain, parallel testing of the TLF pairs yielded an average tensile stress of 8.49 MPa and 1.7MPa (p<0.001) exhibited by the stiffer and less stiff TLF samples, respectively. Similarly, TLF-ES parallel testing resulted in average tensile stresses of 7.19 MPa and 0.079 MPa of the TLF and ES (p<0.002)., Conclusion: Results suggest elevated loading towards stiffer TLF samples relative to less stiff TLF and ES samples. In soft tissues affected by LBP, skewed stress distributions may result in the TLF withstanding the majority of stress, yielding cyclical stress shielding that may contribute to and/or promote LBP., Significance: This novel study demonstrates a potential load allocation bias towards the TLF, laying the foundation for stress shielding within lumbar musculoskeletal soft tissues affected by degenerative musculoskeletal conditions.

Transspinal (or transcutaneous spinal cord) stimulation is a promising noninvasive method that may strengthen the intrinsic spinal neural connectivity in neurological disorders. In this study we assessed the effects of cervical transspinal stimulation on the amplitude of leg transspinal evoked potentials (TEPs), and the effects of lumbosacral transspinal stimulation on the amplitude of arm TEPs. Control TEPs were recorded following transspinal stimulation with one cathode electrode placed either on Cervical 3 (21.3 ± 1.7 mA) or Thoracic 10 (23.6 ± 16.5 mA) vertebrae levels. Associated anodes were placed bilaterally on clavicles or iliac crests. Cervical transspinal conditioning stimulation produced short latency inhibition of TEPs recorded from left soleus (ranging from - 6.11 to -3.87% of control TEP at C-T intervals of -50, -25, -20, -15, -10, 15 ms), right semitendinosus (ranging from - 11.1 to -4.55% of control TEP at C-T intervals of -20, -15, 15 ms), and right vastus lateralis (ranging from - 13.3 to -8.44% of control TEP at C-T intervals of -20 and - 15 ms) (p < 0.05). Lumbosacral transspinal conditioning stimulation produced no significant effects on arm TEPs. We conclude that in the resting state, cervical transspinal stimulation affects the net motor output of leg motoneurons under the experimental conditions used in this study. Further investigations are warranted to determine whether this protocol may reactivate local spinal circuitry after stroke or spinal cord injury and may have a significant effect in synchronization of upper and lower limb muscle synergies during rhythmic activities like locomotion or cycling., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study investigated the effect of the prone trunk extension test (PTE) on lumbar and lower limb muscle stiffness to explore the optimal angle for lumbar muscle training, understand the peripheral muscle force transmission effect, and determine the modulation strategy and interaction mode of different muscles during PTE. Twenty healthy young females were recruited for this study, and the stiffness of the erector spinae (ES), semitendinosus (ST), biceps femoris (BF), medial head of the gastrocnemius (MG), and lateral head of the gastrocnemius (LG) was measured by MyotonPRO under four angular PTE conditions (0° horizontal position, 10°, 20°, and 30°). With the increasing angle, the stiffness of ES decreased gradually, while ST and BF increased first and then decreased. The stiffness of MG and LG increased first, then decreased, then increased. There was a moderate to strong negative correlation between ES stiffness variation and ST (r = -0.819 to -0.728, p < 0.001), BF (r = -0.620 to -0.527, p < 0.05), MG (r = -788 to -0.611, p < 0.01), and LG (r = -0.616 to -0.450, p < 0.05). Horizontal PTE maximizes the activation of ES. There is a tension transfer between the ES, hamstrings, and gastrocnemius, mainly between the ES, ST, and LG. The study provides data to explore the effect of peripheral muscle force transmission and the modulation strategies of different muscles during trunk extension., (© 2023 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Traditional measurements of gait are typically performed in clinical or laboratory settings where functional assessments are used to collect episodic data, which may not reflect naturalistic gait and activity patterns. The emergence of digital health technologies has enabled reliable and continuous representation of gait and activity in free-living environments. To provide further evidence for naturalistic gait characterization, we designed a master protocol to validate and evaluate the performance of a method for measuring gait derived from a single lumbar-worn accelerometer with respect to reference methods. This evaluation included distinguishing between participants' self-perceived different gait speed levels, and effects of different floor surfaces such as carpet and tile on walking performance, and performance under different bouts, speed, and duration of walking during a wide range of simulated daily activities. Using data from 20 healthy adult participants, we found different self-paced walking speeds and floor surface effects can be accurately characterized. Furthermore, we showed accurate representation of gait and activity during simulated daily living activities and longer bouts of outside walking. Participants in general found that the devices were comfortable. These results extend our previous validation of the method to more naturalistic setting and increases confidence of implementation at-home., (© 2024. The Author(s).)

Objectives: To evaluate the lumbar core stability in club-level cricket bowlers., Methods: This descriptive cross-sectional study was conducted in the twin cities of Rawalpindi and Islamabad in Pakistan from July 15 to December 10, 2022, after approval from the ethics review board Foundation University Medical College, Islamabad, and comprised male, club-level, hard-ball cricket bowlers aged 18-24 years. Data was collected through a self-structured demographic sheet, and core stability was assessed using McGill Torso Muscle Endurance Test Battery. Data was analysed using SPSS 21., Results: There were 296 male subjects with a mean age of 20.1±1.77 years. Of them, 90(30.4%) bowlers had good lumbar flexion-to-extension ratio and 206(69.6%) had poor ratio. Lateral endurance test of right-to-left side-bridge ratio showed 71(24%) players in the good category, and 225(76%) in the poor category. The ratio of right lateral endurance to lumbar extensor was good in 55(18.6%) and poor in 241(81.4%) subjects. The ratio of left lateral endurance to lumbar extensor endurance was good in 40(13.5%) players and poor in 256(86.5%)., Conclusions: Lumbar core stability was found to be quite poor among club-level cricket bowlers of Rawalpindi and Islamabad.

The functional importance of trunk muscle strength for running movement is widely recognised, but the kinematic effects of undertaking specific training are unclear. This study investigated the change in joint angle and its variability during running following trunk muscle training. Eighteen young female and novice runners participated. Using Plug-in-gait model with infrared markers attached to the body surface, the lower limb and lumber angles during running were measured, and the variability was examined by calculating the coefficient variation and Lyapunov exponent. Measurements of trunk endurance were also performed. Over four weeks of training, the subjects performed trunk muscle endurance trainings three times a week. Following this intervention, trunk endurance was found to have significantly increased. The Lyapunov exponent of lumbar flexion-extension angle also significantly increased. Moreover, a decreased range of the ankle angle and increased range of the hip angle were observed following the training. These results demonstrate that the trunk training promoted adjustments to lumbar movement and altered the movement patterns of the participants' lower limbs during running.

It is unknown how structural (sex, stature, body mass) and functional (strength, flexibility) personal factors influence lifting strategy in paramedic work. We explored whether variance in peak low back forces and kinematic coordination patterns could be explained by structural and functional personal factors in paramedic lifting tasks. Seventy-two participants performed backboard and stretcher lifts. Peak low back forces normalised to body mass, as well as kinematic coordination patterns, were calculated as dependent variables. Being female, stronger, shorter, having higher body mass, and/or having greater lower body range of motion (ROM) were all independently associated with lower normalised low back forces across backboard and stretcher lifting. Females and stronger individuals seemed to define a movement objective to consistently minimise compressive forces, while individuals with greater hip ROM consistently minimised anteroposterior shear forces. The efficacy of improving strength and hip ROM to reduce low back forces in paramedic lifting should be investigated. Practitioner summary: Females, stronger individuals, and individuals with greater hip range of motion consistently exhibited lower normalised low back forces in paramedic lifting. Improving strength and hip range of motion via training is a potential proactive ergonomics approach to reduce peak low back forces in paramedic lifting tasks.

We explore the effect of stress-recovery schedule on the cumulative creep response of lumbar tissues. Twelve participants performed a 48-minute protocol that consisted of 12 min of full trunk flexion and 36 min of upright standing. Two stress-recovery (work-rest) schedules were considered: a) three minutes of full trunk flexion followed by twelve minutes of upright standing (3:12), and b) one minute of full trunk flexion followed by four minutes of upright standing (1:4). Lumbar kinematics and EMG activity of erector spinae muscles were collected. Cumulative creep deformation was explored by considering the changes in peak lumbar flexion angles during full flexion and changes in the angles of flexion-relaxation (EMG-off) of the lumbar extensor musculature after the 48-minute protocol. The results of time-dependent lumbar flexion angle during full flexion revealed a noticeable creep response in both work-rest schedules, but the cumulative creep response was significantly greater in the 3:12 schedule (Δ3.5°) than in the 1:4 schedule (Δ1.6°). Similarly, the change in the EMG-off lumbar flexion angle in the 3:12 schedule was significantly greater than in the 1:4 schedule (Δ2.5° vs -Δ0.2°, respectively). These results indicate that the passive lumbar tissues recover their force producing capability more rapidly with shorter cycle times., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To verify the relationship between the indicators of components of lumbar motor control and determine the factors related to the indicators to each of these components., Methods: Twenty-five healthy university students were included in the study. The lumbar spine and hip kinematic parameters of posterior/anterior pelvic tilt (mobility and smoothness), ball catching (reactivity), and forward/backward rocking (adaptive stability) were measured as indicators of lumbar motor control. Lumbar proprioception, trunk muscle strength, and lower trunk muscle thickness were also measured. Kinematic parameters of the lumbar spine and hip were measured using a small accelerometer. The data verified the relevance of indicators of lumbar motor control and the relationship with relevant factors., Results: No significant correlations were found for most lumbar motor control indicators. Lumbar proprioception and rectus abdominis muscle thickness were identified as relevant indicators of lumbar motor control., Conclusions: Each component of lumbar motor control is independent and must be evaluated for the component whose function is required. Additionally, some components of lumbar motor control are associated with lumbar proprioception and rectus abdominis muscle thickness; thus, evaluation of these components is necessary when evaluating lumbar motor control., Competing Interests: The authors have no conflict of interest.

Background: This study validates real-time biofeedback for lumbopelvic control training in baseball. The lumbopelvic region is crucial for generating kinetic energy in pitching. Real-time biofeedback enhances training effectiveness and reduces injury risk. The validity and reliability of this system were examined., Purpose: This study was to investigate the validity and reliability of the real-time biofeedback system for lumbopelvic control training., Methods: Twelve baseball players participated in this study, with data collected in two sessions separated by a week. All participants needed to do the lateral slide exercise and single-leg squat exercise in each session. Pelvic angles detected by the real-time biofeedback system were compared to the three-dimensional motion capture system (VICON) during training sessions. Additionally, pelvic angles measured by the biofeedback system were compared between the two training sessions., Results: The real-time biofeedback system exhibited moderate to strong correlations with VICON in both exercises: lateral slide exercise ( r = 0.66-0.88, p < 0.05) and single-leg squat exercise ( r = 0.70-0.85, p < 0.05). Good to excellent reliability was observed between the first and second sessions for both exercises: lateral slide exercise (ICC = 0.76-0.97) and single-leg squat exercise (ICC = 0.79-0.90)., Conclusions: The real-time biofeedback system for lumbopelvic control training, accurately providing the correct pelvic angle during training, could enhance training effectiveness.

Muscle fatigue is prevalent across different aspects of daily life. Tracking muscle fatigue is useful to understand muscle overuse and possible risk of injury leading to musculoskeletal disorders. Current fatigue models are not suitable for real-world settings as they are either validated using simulations or non-functional tasks. Moreover, models that capture the changes to muscle activity due to fatigue either assume a linear relationship between muscle activity and muscle force or utilize a simple muscle model. Personalised electromygraphy (EMG)-driven musculoskeletal models (pEMS) offer person-specific approaches to model muscle and joint kinetics during a wide repertoire of daily life tasks. These models utilize EMG, thus capturing central fatigue-dependent changes in multi-muscle bio-electrical activity. However, the peripheral muscle force decay is missing in these models. Thus, we studied the influence of fatigue on a large scale pEMS of the trunk. Eleven healthy participants performed functional asymmetric lifting task. Average peak body-weight normalized lumbosacral moments (BW-LM) were estimated to be 2.55 ± 0.26 Nm/kg by reference inverse dynamics. After complete exhaustion of the lower back, the pEMS overestimated the peak BW-LM by 0.64 ± 0.37 Nm/kg. Then, we developed a time-varying muscle force decay model resulting in a time-varying pEMS (t-pEMS). This reduced the difference between BW-LM estimated by the t-pEMS and reference to 0.49 ± 0.14 Nm/kg. We also showed that five fatiguing contractions are sufficient to calibrate the t-pEMS. Thus, this study presents a person and muscle specific model to track fatigue during functional tasks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Previous studies have demonstrated changes in lumbar multifidus muscle (LM) contractility after motor control exercises (MCE), and it has been hypothesized that adding neuromuscular electrical stimulation (NMES) may help to re-activate motor units., Objective: To present the effects of combined NMES and MCE on LM contractility, spatial and temporal motor unit recruitment, and movement control in a patient with recurrent low back pain (rLBP)., Methods: Motion tracking system was used to measure quality of movement (smoothness) during an active forward bend, while ultrasound imaging and decomposition electromyography were used to measure the LM contractility and motor unit recruitment during the Sorensen test. These data were collected pre and post intervention. Perceived improvement was also recorded., Results: Improved movement smoothness post intervention was found, with increases in LM contractility from 68.1% to 97.7%, and from 74.2% to 86.7% on the right and left sides, respectively. Number of motor unit increased from 14 to 18 units, while mean firing rate decreased from 10.9 to 7.1 pulses/second post intervention. The patient also reported a perceived improvement of +2 on the Global Rating of Change (GROC). However, this change was not greater than +3 to be considered as minimal clinically important difference., Conclusion: These findings indicate improvements in movement control, LM contractility, and changes in spatial and temporal motor unit recruitment in the study patient, suggesting the potential clinical utility and the need for further research on combined NMES and MCE in the treatment of patients with rLBP.

Lumbar exoskeleton has potential to assist in lumbar movements and thereby prevent impairment of back muscles. However, due to limitations of evaluation tools, the effect of lumbar exoskeletons on coordinated activities of back muscles is seldom investigated. This study used the surface electromyography (sEMG) topographic map based on multi-channel electrodes from low back muscles to analyze the effects. Thirteen subjects conducted two tasks, namely lifting and holding a 20kg-weight box. For each task, three different trials, not wearing exoskeleton (NoExo), wearing exoskeleton but power-off (OffExo), and wearing exoskeleton and power-on (OnExo), were randomly conducted. Root-mean-square (RMS) and median-frequency (MDF) topographic maps of the recorded sEMG were constructed. Three parameters, average pixel values, distribution of center of gravity (CoG), and entropy, were extracted from the maps to assess the muscle coordinated activities. In the lifting task, results showed the average pixel values of RMS maps for the NoExo trial were lower than those for the OffExo trial ( [Formula: see text]) but the same as those for the OnExo trial ( [Formula: see text]0.05). The distribution of CoG showed a significant difference between NoExo and OnExo trials ( [Formula: see text]). In the holding task, RMS and MDF maps' average pixel values showed significant differences between NoExo and OnExo trials ( [Formula: see text]). These findings suggest that active lumbar exoskeletons can reduce the load on low back muscles in the static holding task rather than in the dynamic lifting task. This proves sEMG topographic maps offer a new way to evaluate such effects, thereby helping improve the design of lumbar exoskeleton systems.

Background: Weightlifting is an Olympic sport for dynamic strength and power, and requires the execution of different lifting techniques It is important to analyze the forces subjected to the lower back during weightlifting movements to prevent injuries. Digital Human Modeling (DHM) is a powerful tool that can be used to analyze and optimize the performance of humans while doing their work or activities., Objective: The purpose of this study is to present a simulation analysis of the lower back forces during the execution of two weightlifting techniques: Snatch (SN) and Clean & Jerk (CJ), with different loads and for both genders., Methods: Digital Human modelling through JACK simulation package was used analyze the forces exerted on the lumbosacral area (L5-S1) of the lower back in order to determine the risk for low back injuries. The level of compression and shear forces recommended by the literature have been set as thresholds. The simulaitons were performed in male and female models, with loads from 20-100 kg., Results: The results show that any weight higher than 60 kg in both movements poses risk for the weightlifters in terms of compression and shear forces. It has been observed that weightlifters can lift greater loads in the CJ technique compared to the SN technique. Furthermore, females are able to lift higher loads with lower risk of injuries., Conclusion: Weightlifting is a high-risk activity due to the high levels of shear and compression forces that the body is exposed to during the lifting techniques. Digital Human Modeling holds significant value due to their ability to facilitate the exploration of diverse conditions within a safe environment, devoid of any potential harm to human subjects.

Background: Multifidus is an important lumbar muscle with distinct superficial and deep fibers responsible for torque production and stabilization, respectively. Its mechanical properties change when transitioning from lying to sitting positions, necessitating enhanced stability. It holds crucial clinical relevance to assess these layers separately, especially in the sitting posture, which demands increased neuromuscular control compared to the prone position., Objective: To compare lumbar multifidus stiffness in lying versus sitting postures, analyzing both superficial and deep layers., Methods: Supersonic Shear Imaging captured elastographic images from 26 asymptomatic volunteers in prone and seated positions., Results: Left multifidus shear modulus in lying: 5.98 ± 1.80/7.96 ± 1.59 kPa (deep/superficial) and sitting: 12.58 ± 4.22/16.04 ± 6.65 kPa. Right side lying: 6.08 ± 1.97/7.80 ± 1.76 kPa and sitting: 13.25 ± 4.61/17.95 ± 7.12 kPa. No side differences (lying p= 0.99, sitting p= 0.43). However, significant inter-postural differences occurred., Conclusion: Lumbar multifidus exhibits increased stiffness in sitting, both layers affected, with superior stiffness in superficial versus deep fibers. Applying these findings could enhance assessing multifidus stiffness changes, for classifying tension-induced low back pain stages.

Lower back disorders (LBDs) affect a large proportion of the population, and treatment for LBDs have been shifting toward individualized, patient-centered approaches. LBDs are typically associated with poor proprioception. Therefore, there has been a recent uptake in the utilization of wearable sensors that can administer biofeedback in various industrial, clinical, and performance-based settings to improve lumbar proprioception. The aim of this study was to investigate whether wearable sensor-derived acute auditory biofeedback can be used to improve measures of gross lumbar proprioception. To assess this, healthy participants completed an active target repositioning protocol, followed by a training period where lumbar-spine posture referenced auditory feedback was provided for select targets. Target re-matching abilities were captured before and after acute auditory biofeedback training to extract measures related to accuracy and precision across spine flexion targets (i.e., 20%, 40%, 60%, 80% maximum). Results suggest a heterogenous response to proprioceptive training whereby certain individuals and spine flexion targets experienced positive effects (i.e., improved accuracy and precision). Specifically, results suggest that mid-range flexion targets (i.e., 40-60% maximum flexion) benefited most from the acute auditory feedback training. Further, individuals with poorer repositioning abilities in the pre-training assessment showed the greatest improvements from the auditory feedback training.

Background: Lumbar stabilization exercises (LSE) provide dynamic trunk stability, promote muscle strength and endurance, and improve low back pain rehabilitation and performance., Objective: To clarify the differences in trunk muscle activity during LSEs on stable and different unstable surfaces., Methods: Fifteen healthy males performed three exercises (elbow-toe, hand-knee, and side bridge) on stable (floor) and unstable surfaces. Muscle activity of the bilateral rectus abdominis, internal oblique, external oblique, and erector spinae were recorded. Data were compared using the Friedman test. Pairwise comparisons were performed using Wilcoxon's signed rank test if significant differences were observed., Results: In the elbow-toe exercise, muscle activity of the rectus abdominis and right internal oblique increased in the following order: floor, low-difficulty, and high-difficulty unstable surface. In the hand-knee exercise, muscle activity of the internal oblique on the lower-extremity elevated side, external oblique, and erector spinae on the upper-extremity elevated side were greater on unstable surface exercise performance. In the side bridge exercise, rectus abdominis muscle activity was highest on a high-difficulty unstable surface., Conclusion: Trunk muscle activity increased during exercise on unstable surfaces. Since the effects of unstable surfaces vary depending on muscle and exercise types, exercise difficulty and surface stability must be considered accordingly.

The introduction of exoskeletons in industry has focused on improving worker safety. Exoskeletons have the objective of decreasing the risk of injury or fatigue when performing physically demanding tasks. Exoskeletons' effect on the muscles is one of the most common focuses of their assessment. The present study aimed to analyze the muscle interactions generated during load-handling tasks in laboratory conditions with and without a passive lumbar exoskeleton. The electromyographic data of the muscles involved in the task were recorded from twelve participants performing load-handling tasks. The correlation coefficient, coherence coefficient, mutual information, and multivariate sample entropy were calculated to determine if there were significant differences in muscle interactions between the two test conditions. The results showed that muscle coordination was affected by the use of the exoskeleton. In some cases, the exoskeleton prevented changes in muscle coordination throughout the execution of the task, suggesting a more stable strategy. Additionally, according to the directed Granger causality, a trend of increasing bottom-up activation was found throughout the task when the participant was not using the exoskeleton. Among the different variables analyzed for coordination, the most sensitive to changes was the multivariate sample entropy.

Low back pain (LBP) is the most common injury in golfers of all abilities. The primary aim of this review was to improve understanding of human golf swing biomechanics associated with LBP. A systematic review using the PRISMA guidelines was performed. Nine studies satisfying inclusion criteria and dually reporting golf swing biomechanics and LBP were identified. Human golf swing biomechanics potentially associated with LBP include: reduced lumbar flexion velocity; reduced transition phase length; reduced lumbar torsional load; earlier onset of erector spinae contraction; increased lumbar lateral flexion velocity; reduced or greater erector spinae activity; and earlier onset of external oblique contraction. These potential associations were undermined by a very limited and conflicting quality of evidence, study designs which introduced a severe potential for bias and a lack of prospective study design. There is no conclusive evidence to support the commonly held belief that LBP is associated with "poor" golf swing technique. The potential associations identified should be further investigated by prospective studies of robust design, recruiting participants of both sexes and dexterities. Once firm associations have been identified, further research is required to establish how this knowledge can be best integrated into injury prevention and rehabilitation.

This study aims to identify how spatial distribution of lumbar muscle activity is modulated by different fatigue tasks. Twenty healthy adults performed two different isometric trunk extension endurance tasks (the modified Sorensen test and the inverted modified Sorensen test) until exhaustion. During these tasks, bilateral superficial lumbar muscle activity was recorded using high-density electromyography. The spatial distribution of activation within these muscles was obtained using the centroid coordinates in the medio-lateral and cranio-caudal directions. The effects of task and endurance time (left and right sides) were investigated using repeated measures ANOVA. Results revealed a significant lateral shift of the centroid throughout the fatigue tasks on both sides and no difference between tasks. Significant task × time interaction effects were found for the cranio-caudal direction on both sides showing a significantly more caudal location of the centroid in the modified Sorensen test compared to the inverted test at the beginning of the tasks. Our findings suggest that spatial distribution of lumbar muscle activity is task-dependent in a pre-fatigue stage while an alternative but similar muscle recruitment strategy is used in both tasks to maintain performance in the later stages of muscle fatigue., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Quantifying the trunk flexion angles at which wearable support systems (exoskeletons/exosuits) provide substantial trunk extension moment during posture maintenance tasks (such as those seen in surgical environments) can provide a deeper understanding of this potential intervention strategy. Understanding how time (i.e. adaptation/learning) might impact the reliance on wearable support is also of value. Sixteen participants were asked to maintain specific trunk flexion angles (range 0-60°) with and without an exosuit system while erector spinae and rectus abdominis muscle activity were captured using surface electromyography. The effects of the exosuit showed a statistically significant ( p  < 0.007) effect on the activity of the erector spinae muscles at 10-60°-an effect that became 'large' (Cohen's d = 0.84) after 20° of trunk flexion. There were no meaningful time-dependent trends in the levels of muscle activation indicating there was no adaptation/learning effect of the exosuit in the task studied. Practitioner summary: This study examined the effectiveness of a back-support exosuit as a function of trunk flexion angle and time of use. The results revealed that the exosuit significantly reduced erector spinae muscle activity beyond 20° of trunk flexion but did not show a meaningful adaption/learning effect. Abbreviations: LBP: low back pain; EMG: electromyography; NEMG: normalized electromyography; IMU: inertial measurement unit; ES: erector spinae; RA: rectus abdominis; MVC: maximum voluntary contraction; FFT: Fast Fourier Transform.

The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable postures are biomechanical risk factors for developing MSS. Ergonomic devices such as exoskeletons are possible solutions that can reduce muscle and joint load. To design effective exoskeletons for surgeons, one needs to quantify which neck and trunk postures are seen and how much support during actual surgery is required. Hence, this study aimed to establish the biomechanical profile of neck and trunk postures and neck and lumbar joint loads during open surgery (training). Eight surgical trainees volunteered to participate in this research. Neck and trunk segment orientations were recorded using an inertial measurement unit (IMU) system during open surgery (training). Neck and lumbar joint kinematics, joint moments and compression forces were computed using OpenSim modelling software and a musculoskeletal model. Histograms were used to illustrate the joint angle and load distribution of the neck and lumbar joints over time. During open surgery, the neck flexion angle was 71.6% of the total duration in the range of 10~40 degrees, and lumbar flexion was 68.9% of the duration in the range of 10~30 degrees. The normalized neck and lumbar flexion moments were 53.8% and 35.5% of the time in the range of 0.04~0.06 Nm/kg and 0.4~0.6 Nm/kg, respectively. Furthermore, the neck and lumbar compression forces were 32.9% and 38.2% of the time in the range of 2.0~2.5 N/kg and 15~20 N/kg, respectively. In contrast to exoskeletons used for heavy lifting tasks, exoskeletons designed for surgeons exhibit lower support torque requirements while additional degrees of freedom (DOF) are needed to accommodate combinations of neck and trunk postures.

Lumbar joint compression forces have been linked to the development of chronic low back pain, which is specially present in occupational environments. Offline methodologies for lumbosacral joint compression force estimation are not commonly integrated in occupational or medical applications due to the highly time-consuming and complex post-processing procedures. Hence, applications such as real-time adjustment of assistive devices (i.e., back-support exoskeletons) for optimal modulation of compression forces remains unfeasible. Here, we present a real-time electromyography (EMG)-driven musculoskeletal model, capable of estimating accurate lumbosacral joint moments and plausible compression forces. Ten participants performed box-lifting tasks (5 and 15 kg) with and without the Laevo Flex back-support exoskeleton using squat and stoop lifting techniques. Lumbosacral kinematics and EMGs from abdominal and thoracolumbar muscles were used to drive, in real-time, subject-specific EMG-driven models, and estimate lumbosacral joint moments and compression forces. Real-time EMG-model derived moments showed high correlations (R 2 = 0.76 - 0.83) and estimation errors below 30% with respect to reference inverse dynamic moments. Compared to unassisted lifting conditions, exoskeleton liftings showed mean lumbosacral joint moments and compression forces reductions of 11.9 - 18.7 Nm (6 - 12% of peak moment) and 300 - 450 N (5 - 10%), respectively. Our modelling framework was capable of estimating in real-time, valid lumbosacral joint moments and compression forces in line with in vivo experimental data, as well as detecting the biomechanical effects of a passive back-support exoskeleton. Our presented technology may lead to a new class of bio-protective robots in which personalized assistance profiles are provided based on subject-specific musculoskeletal variables., Competing Interests: Declaration of competing interest The authors declare that they have no competing and/or financial interests that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study aimed to analyze the position of the lumbopelvic region and lumbar muscle activity in the most common breastfeeding positions. We recorded the curvatures of the lumbar spine and pelvis by means of an electrogoniometer, and the muscle activation levels of the erector spinae with electromyography, in 34 women in erect standing and breastfeeding their children in several positions. Both side lying and clutch-hold positions showed a greater degree of lumbar spine flexion compared to standing. In all sitting postures it was observed that the pelvis was placed in retroversion when compared to standing and side lying. In muscle activity, it was observed that the activation intensity of the right erector in the right side-supported side lying position was significantly lower compared to the rest of breastfeeding postures and standing. Side lying may be a better position to avoid muscle fatigue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study aimed to determine the effect of physiotherapists' physical burden caused by different bed heights during manual therapy. Thirty-three male physiotherapists performed tasks simulating lumbar massage and passive hip abduction range-of-motion exercise (ROM) on the beds with low height (LH) and adjusted height (AH), with each task performed three times. The anterior inclination angle of the physiotherapist's trunk was measured, the surface electromyograms of the erector spinae and trapezius muscles were recorded, and perceived stress was assessed. The indexes obtained were statistically compared for different bed heights. Additionally, the lumbar disc compression force and flexion torque were estimated. The lumbar burden caused by the excessive bending and the biomechanical burden and perceived stress were stronger at LH than AH. In ROM tasks using the right hand, the muscle activity was lower at the left lumbar region at LH than at AH. At LH, the anterior inclination angle increased and the lumbar muscle activity declined as the number of tasks increased. The burden on the shoulders was not significantly different by bed heights. Our results showed that, when physiotherapists perform manual therapy, it is necessary to adjust the bed height to reduce physical burden and ensure higher quality of service.

Previous studies that tested passive back-support exoskeletons focused only on active low-back tissue. Therefore, this study examines the effect from a passive back-support exoskeleton by investigating changes in the load transfer mechanism between active and passive tissue in the low back. Twelve healthy male participants performed a full range of trunk flexion-extension movements under three conditions-FREE (no exoskeleton), the backX, or the CoreBot exoskeleton-while holding 0 kg, 4 kg, and 8 kg loads. Body kinematics and electromyography were recorded. Results showed that the average muscle activity of the lumbar erector spinae (LES) was significantly reduced while wearing the exoskeletons, with a 5.9%MVC reduction with the backX and a 3.3%MVC reduction with the CoreBot. Earlier occurrence of the flexion-relaxation phenomenon induced by the trunk extension moment of exoskeletons played an important role in reducing LES muscle activity because the LES returned to a relaxed state earlier (EMG-Off: a 3.1° reduction with the backX, and a 1.8° reduction with the CoreBot; EMG-On: a 2.3° reduction with the backX, and a 1.4° reduction with the CoreBot). In addition, the maximum lumbar flexion angle (a 2.2° reduction with the backX and a 1.5° reduction with the CoreBot) showed significant decreases compared to the FREE condition, indicating that exoskeleton use can prevent low-back passive tissue from being fully activated. These results suggested the overall effects of passive back-support exoskeletons in reducing loads on both active and passive tissue in the low back., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

In modern developed societies, heavy physical demands are decreasing and getting replaced by longer periods of static, low-exertion activities such as sitting or standing. To counteract this lack of physical activity, more and more people are engaging in physical activity through exercise and training. Virtually opposite training modalities are endurance and strength. We asked if back muscle endurance capacity is influenced by training mode. 38 healthy male subjects (age range 19-31 years, mean age 22.6 years) were investigated: sedentary (Control, n = 12), endurance trained (ET, n = 13), and strength trained participants (ST, n = 13). They underwent a ten-minutes isometric extension task at 50% of their upper body weight. Surface EMG was measured in the low-back region utilizing quadratic 4*4 monopolar electrode montages per side. Relative amplitude and mean frequency changes were analysed with respect to electrode position and group during the endurance task. Eight ST subjects failed to complete the endurance task. Relative amplitude and frequency changes were largest in the ST group, followed by Control and ET groups (amplitude: F 6.389, p 0.004, frequency: F 11.741, p<0.001). Further, independent of group largest amplitude increase was observed for the most upper and laterally positioned electrodes. Mean frequency changes showed no systematic spatial distribution pattern. Although, in the light of an aging population, strength training has its merits our results question the functional suitability of frequent and isolated high-impact strength training for everyday endurance requirements like doing the dishes. Fatigue related amplitude elevations are systematically distributed in the back region, showing least fatigue signs for the most caudal and medial, i.e. the lumbar paravertebral region., Competing Interests: The authors have declared that no competing interests exist.

Astronauts frequently report microgravity-induced back pain, which is generally more pronounced in the beginning of a spaceflight. The dry immersion (DI) model reproduces the early effects of microgravity in terms of global support unloading and fluid shift, both of which are involved in back pain pathogenesis. Here, we assessed spinal changes induced by exposure to 5 days of strict DI in 18 healthy men (25-43-yr old) with ( n = 9) or without ( n = 9) thigh cuffs countermeasure. Intervertebral disk (IVD) height, spinal cord position, and apparent diffusion coefficient (ADC; reflecting global water motion) were measured using magnetic resonance imaging before and after DI. After DI, IVD height increased in thoracic (+3.3 ± 0.8 mm; C 7 -T 12 ) and lumbar (+4.5 ± 0.4 mm; T 12 -L 5 ) regions but not in the cervical region (C 2 -C 7 ) of the spine. An increase in ADC after DI was observed at the L 1 (∼6% increase, from 3.2 to 3.4 × 10 -3 mm 2 /s; P < 0.001) and L 2 (∼3% increase, from 3.4 to 3.5 × 10 -3 mm 2 /s; P = 0.005) levels. There was no effect of thigh cuffs on spinal parameters. This change in IVD after DI follows the same "gradient" pattern of height increase from the cervical to the lumbar region as observed after bed rest and spaceflight. The increase in ADC at L 1 level positively correlated with reported back pain. These findings emphasize the utility of the DI model for studying early spinal changes observed in microgravity.

Objective: The purpose of the study was to examine the effectiveness of a novel supported dynamic lumbar extension with the abdominal drawing-in maneuver (ADIM) technique on stature change, deep abdominal muscle activity, trunk muscle fatigue, and pain intensity during prolonged sitting in chronic low back pain (CLBP) participants., Background: Prolonged sitting can cause trunk muscle fatigue from continuous contraction of deep trunk muscles in seated postures. Deficiency of activity of deep muscles can reduce muscular support of the spine, causing stress on spinal structures, which could result in pain., Method: Thirty participants with CLBP were randomly allocated: (a) control-sitting without exercise, and (b) intervention-supported dynamic lumbar extension with the ADIM technique., Results: Compared to the intervention condition, the control condition demonstrated significantly greater deterioration in stature change, increased levels of deep trunk muscle fatigue, and an increase in pain during prolonged sitting., Conclusion: The supported dynamic lumbar extension with the ADIM technique appears to provide a protective effect on detrimental stature change and deep trunk muscle fatigue. In addition, it prevented an increase in pain intensity during prolonged sitting in people with CLBP., Application: Sedentary behavior harms health, particularly affecting the lower back. Clinicians can use the intervention to induce dynamic lumbar movement, and this exercise can maintain deep trunk muscle activity during prolonged sitting, thereby helping to prevent low back pain (LBP) problems.

Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.

This study was designed to identify neuromuscular adaptations of low back pain (LBP) cyclists , and the impact of a cycling effort on spinal shrinkage. Forty-eight trained cyclists rode their road bike on a smart trainer for 1-hour. Surface electromyography (EMG) recorded muscle activity of the lumbar erector spinae (LES), 3D motion analysis system recorded kinematic of the trunk, and stadiometry measured spinal height. Statistical comparisons were made using repeated measure ANOVAs. The LBP group presented increase in pain levels throughout the effort ( p < 0.001). A significant group difference was only observed for the thoracic angle ( p = 0.03), which was less flexed for LBP. The one-hour cycling effort (time effect) significantly increased the trunk flexion ( p <  0.001) and thoracic flexion ( p < 0.001) for both groups. Significant lower LES activation (35% less) was observed at the end of the effort  as well as a decrease in spinal height ( p = 0.01) for both groups. Neuromuscular adaptations to cycling effort is identified by a decrease in LES EMG amplitude and an increase flexion of the trunk. Adaptation to pain is seen by an increase in thoracic flexion. Despite these adaptations, LBP cyclists could not ride their bike pain-free.

Purpose: Workers who perform repetitive movements are exposed to many risk factors leading to the occurrence of lumbar back pain. The aim of the research was to answer the question whether the ergonomic instruction conducted by a physiotherapist would change the tested range of motion of the segments of lumbar spine and the symmetry of the work of the torso and upper limbs muscles during work performed by foundry employees., Methods: The study included 12 foundry production line workers with musculoskeletal pain. The workstation was built in the laboratory that perfectly simulates work on the production line. The workers performed two activities from their daily work, i.e. transferring and moving a casting. They were then given ergonomic instruction by a physiotherapist and performed the assigned tasks again. During the activities, the electromyographic signal from five muscles was recorded in terms of symmetry of their work. The maximum angular ranges of the motor segments of the lumbar spine were measured using gyroscopes., Results: After the ergonomic instruction, the contralateral imbalance of muscle activity decreased statistically significantly during the first phase ( p  = 0.0004), second phase ( p  = 0.0002) and the third phase ( p  = 0.0069) of transferring the casting. While moving the casting , only erector spinae showed statistically significantly ( p  = 0.0131) more symmetrical work after the ergonomic instruction. During the transfer of the casting, statistically significantly lower values of the ranges of motion between the segments were obtained after carrying out the ergonomic instruction for the left ( p  = 0.0231) and right ( p  = 0.0032) lateral flexion. The ranges of movement between the segments differed statistically significantly for the flexion ( p  = 0.0117), extension ( p  = 0.0469) and left ( p  = 0.0031) and right lateral flexion movements ( p  = 0.0012)., Conclusion: Conducting ergonomic instruction consisting in teaching the correct performance of a movement task reduced the contralateral imbalance of muscle activity and changes the ranges of movement of L1-S1 segments. The task of optimizing the load on the musculoskeletal system, including the lumbar spine, should be carried out by means of appropriate ergonomic instruction and multi-pronged measures, including analysis of the health of employees, their working environment and physical activity outside the workplace. Electromyography and measurements of the range of movement of the lumbar spine appear to be good tools for the evaluation of workplace ergonomics., Competing Interests: The authors declare there are no competing interests., (©2022 Błaszczyk and Ogurkowska.)

Background: New motor adaptation to pain theory suggests that patients with low back pain (LBP) use the lumbopelvic stiffening strategy by redistribution of within and between muscle activities to protect painful structure. This could result in an altered postural control of the lumbopelvic region during active prone hip rotation (PHR)., Objective: To investigate coordination and timing of lumbopelvic and hip movements, and smoothness of the lumbopelvic control during PHR between participants with and without LBP., Methods: Eight participants with LBP and eight participants without LBP were recruited. The electromagnetic tracking system was used to record kinematic data during PHR. Cross-correlation between hip rotation and lumbopelvic movement in the transverse plane was calculated. Correlation at zero time-lag, time-lag, correlation at time-lag, and maximal lumbopelvic motion were derived. Frequency of movement disruption was identified. An independent t-test was used in conjunction with the effect size and 95% minimal detectable difference (MDD95) to determine the difference in kinematic parameters., Results: Participants with LBP demonstrated a significant delay (exceeding MDD95) in lumbopelvic motion while nonsignificant frequency of disrupted motion on the painful side PHR demonstrated a trend with a large effect size that exceeded MDD95. There were trends with moderate to large effect sizes and differences exceeding MDD95 in delay of lumbopelvic motion with greater movement disruption on the nonpainful side in participants with LBP., Conclusion: Participants with LBP used a lumbopelvic stiffening strategy for postural control to protect painful structures; however, the stiffening might complicate efforts to smoothly control lumbopelvic movement.

Lower back pain and related injuries are prevalent and serious problems in various industries, and high compression force to the lumbosacral (L5/S1) region has been known as one of the key factors. Previous research on passive lower back exoskeletons focused on reducing lumbar muscle activation by providing an extensor moment. Additionally, lumbar traction forces can reduce the compression force, and is a common treatment method for lower back pain in clinics. In this paper, we propose a novel passive lower back exoskeleton that provides both extensor moment and lumbar traction force. The working principle of the exoskeleton, extending the coil springs during lumbar flexion, and its design criteria regarding the amount of each force element were provided. The kinematic model explained its operation, and the dynamic simulation estimated its performance and validated its satisfaction with the design criteria. The biomechanical model provided a brief insight into the expected exoskeleton's effect on the reduced lower back compression force. Ten subjects performed static holding and dynamic lifting tasks, and the generated force elements in two directions, parallel and perpendicular to the trunk, were evaluated using a force sensor and electromyography sensors, respectively. The experiment demonstrated a pulling force opposite to the direction of intradiscal pressure and reduced erector spinae activation. This implies the effect of wearing the exoskeleton to decrease the intervertebral pressure during static back bending or heavy lifting tasks.

Background: Many studies have compared muscle length and muscle activity for low back pain. However, compensatory movement for non-specific low back pain has not yet been studied sufficiently., Objective: The purpose of this study was to compare the length of the hip flexor, lumbar extensor endurance and the muscle activity of the erector spinae and gluteus maximus during hip extension, and the compensatory movement of the lumbar in people with or without nonspecific chronic low back pain., Methods: In this case-control study, 16 participants with non-specific chronic LBP and 17 without LBP were included. Hip flexor length was assessed by the modified Thomas test. Lumbar extensor endurance was assessed by the modified Biering-Sorensen test. Muscle activity of the erector spinae and gluteus maximus during hip extension was measured using a Delsys-Trigno wireless EMG system. Compensatory lumbar movements during hip extension were measured using a digital inclinometer., Results: Muscle activity of the erector spinae and compensatory lumbar movements were significantly higher in the LBP group. (p< 0.05). Hip flexor length, muscle activity of the gluteus maximus and endurance of the lumbar extensor were significantly differences in the LBP group (p< 0.05)., Conclusions: Shortened hip flexors, low gluteus maximus activity, and high erector spinae activity during hip extension, lumbar extensor weak endurance, lumbar compensatory movement are potential factors for non-specific LBP.

A deficiency in lumbar muscle blood circulation is considered to be a major risk factor for non-specific low back pain. The aim of this study was to investigate changes in relative circulation over time in the lumbar multifidus in different positions on sitting.Twelve healthy subjects (7 males, 5 females, average age: 20.9 years) without low back pain for the past 12 months were recruited. Near-infrared spectroscopy (NIRS) was used to non-invasively measure total haemoglobin (Total-Hb) and oxygenated haemoglobin (Oxy-Hb) in the lumbar multifidus at the L5-S1 segment. Subjects were asked to move into either 60-degree trunk-flexed or 20-degree trunk-extended position from the starting (standing in neutral) position in 3 s, timed by a metronome, and to maintain these positions for 30 s. The measurements of Total-Hb and Oxy-Hb were compared at -3 (neutral position), 0, 10, 20, and 30 s in each flexed and extended position on sitting.In flexion, Total-Hb and Oxy-Hb of the lumbar multifidus were significantly decreased from a neutral (-3 s) to flexed (0 s) position (Total-Hb: p = 0.002, Oxy-Hb: p = 0.004); however, there were no significant differences in the flexed position. In extension, Total-Hb and Oxy-Hb of the lumbar multifidus were significantly increased from 0 to 10 s (Total-Hb: p < 0.001, Oxy-Hb: p < 0.001); however, there were no significant differences from the neutral (-3 s) to extended (0 s) position, or from 10 to 30 s.The results of this study indicate that the intramuscular circulation of the lumbar multifidus decreases immediately once the trunk starts moving into a flexed position on sitting. On the other hand, the intramuscular circulation of the lumbar multifidus increases for up to 10 s once the trunk starts moving into an extended position., (© 2022. Springer Nature Switzerland AG.)

Among the spinocerebellar projections vital for sensorimotor coordination of limbs and the trunk, the morphology of spinocerebellar axons originating from the lumbar cord has not been well characterized compared to those from thoracic and sacral cords. We reconstructed 26 single spinocerebellar axons labeled by biotinylated dextran injections into the gray matter of the lumbar spinal cord in mice. Axon terminals were mapped with the zebrin pattern of the cerebellar cortex. Reconstructed axons were primarily classified into ipsilaterally and contralaterally ascending axons, arising mainly from the dorsal and ventral horns, respectively. The majority of ipsilateral and contralateral axons took the dorsal-medullary and ventral-pontine pathways, respectively. The axons of both groups terminated mainly in the vermal and medial paravermal areas of lobules II-V and VIII-IXa, often bilaterally but predominantly ipsilateral to the axonal origin, with a weak preference to particular portions of zebrin stripes. The ipsilateral axons originating from the medial dorsal horn in the upper lumbar cord (n = 3) had abundant (43-147) mossy fiber terminals and no medullary collaterals. The ipsilateral axons originating from the lateral dorsal horn in the lower lumbar cord (n = 9) and the contralateral axons (n = 14) showed remarkable morphology variations. The number of their mossy fiber terminals varied from 2 to 172. Their collaterals, observed in 17 axons out of 23, terminated mainly in the medial cerebellar nucleus, nucleus X, and lateral reticular nucleus in various degrees. The results indicated that the lumbar spinocerebellar projection contains highly heterogeneous axonal populations regarding their pathway, branching, and termination patterns., (© 2021 Wiley Periodicals LLC.)

The aim of this study was to determine whether stimulation of sacral spinal nerve roots can induce defecation in cats. In anesthetized cats, bipolar hook electrodes were placed on the S1-S3 dorsal and/or ventral roots. Stimulus pulses (1-50 Hz, 0.2 ms) were applied to an individual S1-S3 root to induce proximal/distal colon contractions and defecation. Balloon catheters were inserted into the proximal and distal colon to measure contraction pressure. Glass marbles were inserted into the rectum to demonstrate defecation by videotaping the elimination of marbles. Stimulation of the S2 ventral root at 7 Hz induced significantly ( P < 0.05) larger contractions (32 ± 9 cmH 2 O) in both proximal and distal colon than stimulation of the S1 or S3 ventral root. Intermittent (5 times) stimulation (1 min on and 1 min off) of both dorsal and ventral S2 roots at 7 Hz produced reproducible colon contractions without fatigue, whereas continuous stimulation of 5-min duration caused significant fatigue in colon contractions. Stimulation (7 Hz) of both dorsal and ventral S2 roots together successfully induced defecation that eliminated 1 or 2 marbles from the rectum. This study indicates the possibility to develop a novel neuromodulation device to restore defecation function after spinal cord injury using a minimally invasive surgical approach to insert a lead electrode via the sacral foramen to stimulate a sacral spinal root. NEW & NOTEWORTHY This study in cats determined the optimal stimulation parameters and the spinal segment for sacral spinal root stimulation to induce colon contraction. The results have significant implications for design of a novel neuromodulation device to restore defecation function after spinal cord injury (SCI) and for optimizing sacral neuromodulation parameters to treat non-SCI people with chronic constipation.

Motoneurons (MNs) control muscle contractions, and their recruitment by premotor circuits is tuned to produce accurate motor behaviours. To understand how these circuits coordinate movement across and between joints, it is necessary to understand whether spinal neurons pre-synaptic to motor pools have divergent projections to more than one MN population. Here, we used modified rabies virus tracing in mice to investigate premotor interneurons projecting to synergist flexor or extensor MNs, as well as those projecting to antagonist pairs of muscles controlling the ankle joint. We show that similar proportions of premotor neurons diverge to synergist and antagonist motor pools. Divergent premotor neurons were seen throughout the spinal cord, with decreasing numbers but increasing proportion with distance from the hindlimb enlargement. In the cervical cord, divergent long descending propriospinal neurons were found in contralateral lamina VIII, had large somata, were neither glycinergic, nor cholinergic, and projected to both lumbar and cervical MNs. We conclude that distributed spinal premotor neurons coordinate activity across multiple motor pools and that there are spinal neurons mediating co-contraction of antagonist muscles., Competing Interests: RR, CL, GB, RB, MB No competing interests declared, (© 2021, Ronzano et al.)

Backgrounds: Finite element analysis (FEA) is an important tool during the spinal biomechanical study. Irregular surfaces in FEA models directly reconstructed based on imaging data may increase the computational burden and decrease the computational credibility. Definitions of the relative nucleus position and its cross-sectional area ratio do not conform to a uniform standard in FEA., Methods: To increase the accuracy and efficiency of FEA, nucleus position and cross-sectional area ratio were measured from imaging data. A FEA model with smoothened surfaces was constructed using measured values. Nucleus position was calibrated by estimating the differences in the range of motion (RoM) between the FEA model and that of an in-vitro study. Then, the differences were re-estimated by comparing the RoM, the intradiscal pressure, the facet contact force, and the disc compression to validate the measured and calibrated indicators. The computational time in different models was also recorded to evaluate the efficiency., Results: Computational results indicated that 99% of accuracy was attained when measured and calibrated indicators were set in the FEA model, with a model validation of greater than 90% attained under almost all of the loading conditions. Computational time decreased by around 70% in the fitted model with smoothened surfaces compared with that of the reconstructed model., Conclusions: The computational accuracy and efficiency of in-silico study can be improved in the lumbar FEA model constructed using smoothened surfaces with measured and calibrated relative nucleus position and its cross-sectional area ratio., (© 2021. The Author(s).)

Purpose: To investigate if lumbar and lower limb kinematics or kinetics are different between groups with and without a history of LBP during lifting. Secondly, to investigate relationships between biomechanical variables and pain ramp during repeated lifting., Methods: 21 LBP and 20 noLBP participants completed a 100-lift task, where lumbar and lower limb kinematics and kinetics were measured during lifting, with a simultaneous report of LBP intensity every 10 lifts. Lifts were performed in a laboratory setting, limiting ecological validity., Results: The LBP group used a different lifting technique to the noLBP group at the beginning of the task (slower and more squat-like). Kinetic differences at the beginning included less peak lumbar external anterior shear force and greater peak knee power demonstrated by the LBP group. However, at the end of the task, both groups lifted with a much more similar technique that could be classified as more stoop-like and faster. Peak knee power remained greater in the LBP group throughout and was the only kinetic difference between groups at the end of the lifting task. While both groups lifted using a more comparable technique at the end, the LBP group still demonstrated a tendency to perform a slower and more squat-like lift throughout the task. Only one of 21 variables (pelvic tilt at box lift-off), was associated with pain ramp in the LBP group. Conclusions: Workers with a history of LBP, lift with a style that is slower and more squat-like than workers without any history of LBP. Common assumptions that LBP is associated with lumbar kinematics or kinetics such as greater lumbar flexion or greater forces were not observed in this study, raising questions about the current paradigm around 'safe lifting'., Competing Interests: The authors have no competing interests to declare.

Objectives: To investigate the accuracy of visual assessments made by physical therapists of lumbo-pelvic movements during the squat and deadlift and how much movement is considered injurious., Design: Quantitative Cross-sectional., Participants: 14 powerlifters, 10 Olympic weightlifters and six physical therapists., Setting: The lifters were recorded simultaneously by video and an inertial measurement unit (IMU) system while performing squats and deadlifts. The physical therapists assessed the videos and rated whether specific lumbo-pelvic movements were visible during the lifts and whether the movement amplitude was considered injurious., Main Outcome Measures: The nominal visual assessments, if there was a movement and if it was considered injurious, were compared to the degrees of movement attained from the IMU system., Results: During the squat, a posterior pelvic tilt of ≥34° was required to visually detect the movement. For other lumbo-pelvic movements, there was no significant difference in the amount of movement between those who were assessed as moving or not moving their lumbo-pelvic area, nor was there a difference in movement amplitude between those who were assessed as having an increased risk of injury or not., Conclusions: Physical therapists did not consistently detect lumbo-pelvic movements during squats and deadlifts when performed by competitive lifters., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Viscoelastic creep of spine tissue, induced by submaximal spine flexion in sitting, can delay the onset of the flexion-relaxation phenomenon (FRP) and low back reflexes (LBR). Theoretically, these two outcome measures should be correlated; however, no studies have investigated this. This study aims to determine whether 30 min of near-maximal spine flexion will affect the onset of FRP and LBR in the lumbar erector spinae (LS) and lumbar multifidus (LM), and to examine the relation between these parameters. 15 participants were recruited (9F, 6M). Spine angle (between L1 and S2) was monitored synchronously with bilateral muscle activity in the LS (L1) and the LM (L4). FRP onset and LBR were measured in a randomized order before and after 30 min of slouched sitting. No significant difference was found for any muscle LBR onset time between pre and post-sitting (p > 0.05). A significant increase in FRP onset was found in the RLM (p = 0.016) following sitting. No significant correlation was found between the FRP and the LBR for any muscle. These results suggest that the LBR onset might not be as sensitive as an outcome measure to investigate shorter exposures of sitting as FRP., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

High-level dressage horses regularly perform advanced movements, requiring coordination and force transmission between front and hind limbs across the thoracolumbosacral region. This study aimed at quantifying kinematic differences in dressage horses when ridden in sitting trot-i.e. with additional load applied in the thoracolumbar region-compared with trotting in-hand. Inertial sensors were glued on to the midline of the thoracic (T) and lumbar (L) spine at T5, T13, T18, L3 and middle of the left and right tubera sacrale of ten elite dressage horses (Mean±SD), age 11±1 years, height 1.70±0.10m and body mass 600±24kg; first trotted in-hand, then ridden in sitting trot on an arena surface by four Grand Prix dressage riders. Straight-line motion cycles were analysed using a general linear model (random factor: horse; fixed factor: exercise condition; covariate: stride time, Bonferroni post hoc correction: P<0.05). Differential roll, pitch and yaw angles between adjacent sensors were calculated. In sitting trot, compared to trotting in-hand, there was increased pitch (mean±S.D), (in-hand, 3.9 (0.5°, sitting trot 6.3 (0.3°, P = <0.0001), roll (in-hand, 7.7 (1.1°, sitting trot 11.6 (0.9°, P = 0.003) and heading values (in-hand, 4.2 (0.8), sitting trot 9.5 (0.6°, P = <0.0001) in the caudal thoracic and lumbar region (T18-L3) and a decrease in heading values (in-hand, 7.1 (0.5°, sitting trot 5.2 (0.3°, P = 0.01) in the cranial thoracic region (T5-T13). Kinematics of the caudal thoracic and lumbar spine are influenced by the rider when in sitting trot, whilst lateral bending is reduced in the cranial thoracic region. This biomechanical difference with the addition of a rider, emphasises the importance of observing horses during ridden exercise, when assessing them as part of a loss of performance assessment., Competing Interests: TP is director of EquiGait Ltd providing gait analysis products and services. RMG is director of Centaur Biomechanics These affiliations does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objectives: The purpose of this study was to compare the efficacy of two different types of exercise methods in patients with adolescent idiopathic scoliosis., Methods: In total, 28 subjects with adolescent idiopathic scoliosis with a mild curve magnitude (10°-26°) were randomly divided into two groups: the Schroth group (n = 14) and the core group (n = 14). The patients in the Schroth group were treated with supervised Schroth exercises, and the patients in the core group were treated with supervised core stabilization exercises; both groups performed the exercises for three days per week for a total of 10 weeks, and both were given additional traditional exercises to perform. Assessment included Cobb angle (Radiography), trunk rotation (Adam's test), cosmetic trunk deformity (Walter Reed Visual Assessment Scale), spinal mobility (Spinal Mouse), peripheral muscle strength (Biodex System 4-Pro), and quality of life (Scoliosis Research Society-22 questionnaire)., Results: It was found that patients in the Schroth group showed greater improvement in Cobb angles, thoracic trunk rotation angle, cosmetic trunk deformity, spinal mobility, and quality of life than those in the core group (p<0.05), except for in lumbar trunk rotation angle. Peripheral muscle strength improvement was greater in the core group than in the Schroth group (p<0.05)., Conclusion: Schroth exercises are more effective than core stabilization exercises in the correction of scoliosis and related problems in mild adolescent idiopathic scoliosis, and core stabilization exercises are more effective than Schroth exercises in the improvement of peripheral muscle strength., Trial Registration: NCT04421157., Competing Interests: The authors have declared that no competing interests exist.

This study aimed to compare the one-repetition maximum (1RM) and the velocity outcomes obtained against the same absolute and relative (%1RM) loads between the flat and arched bench press (BP) variants. Eleven competitive male powerlifters were evaluated in one session with the flat BP (natural lumbar arch and moderate scapular retraction) and in another session with the arched BP (pronounced lumbar arch and scapular retraction). An incremental loading test was used to determine the 1RM as well as the barbell's velocity against the different external loads. The main findings revealed that the 1RM did not significantly differ between the flat (115.9 ± 17.9 kg) and arched (115.7 ± 18.4 kg) BP variants ( p = 0.942, effect size = 0.01), while there were no significant differences between BP variants either for the velocity outcomes obtained against the individual loads nor for the velocities associated with each %1RM ( p > 0.05). These results suggest that competitive powerlifters do not necessarily present their higher 1RM performance using the arched BP variant. Finally, both BP variants could be used interchangeably when using movement velocity for testing upper-body strength as well as for prescribing the load during velocity-based resistance training routines.

Objective: The purpose of this study was to assess the lumbar spine kinematics in 3 movement axes in asymptomatic individuals in the sit-to-stand (STS) movement performed in a habitual, flexion, or extension manner., Methods: There were 30 participants (16 women, 14 men), aged 23 to 37 years. Each participant performed an STS test. We registered the total time of the STS movement and the maximum acceleration of the lumbar spine in the vertical, anteroposterior, and mediolateral axes. The examination of the movement pattern was performed with the use of a BTS G-sensor device., Results: The highest movement dynamics in the lumbar spine were observed during the STS performed in a habitual manner in the 3 axes (P < .01). The lowest movement dynamics ere associated with the extension STS pattern. The flexion pattern differed from the habitual one in total performance time in both groups (P < .01). There were no significant differences in kinematic lumbar spine between sexes., Conclusion: The kinematics of the STS movement for asymptomatic individuals were characterized by significant variability in the maximum acceleration in the 3 axes. The highest movement dynamics were observed during the STS performed in a habitual manner, and the lowest dynamics with the extension pattern of STS., (Copyright © 2021. Published by Elsevier Inc.)

Purpose: In this study we measured neural activation (EMG) in four trunk stabilizer muscles and vastus lateralis (VL) in trained and novice participants during a set of squat repetitions to volitional fatigue at 85% 1RM., Methods: Forty males were recruited into two groups, novice (NG: n = 21) and experienced (EG: n = 19), according to relative squat 1RM. Participants were tested twice to: (1) determine squat 1RM, and (2) complete a single set of repetitions to volitional fatigue at 85% 1RM. Relative squat 1RM; NG < 140% body mass, EG > 160% body mass. Neuromuscular activation was measured by EMG for the following: rectus abdominus (RA), external oblique (EO), lumbar sacral erector spinae (LSES), upper lumbar erector spinae (ULES) and VL in eccentric and concentric phase. Completed repetitions, RPE and EMG in repetition 1 and at 20, 40, 60, 80 and 100% of completed repetitions were analysed., Results: No group differences were found between number repetitions completed and RPE in repetitions to volitional fatigue at 85% 1RM. Neuromuscular activation increased significantly in all muscle groups in eccentric and concentric phase apart from RA in the eccentric phase. Trunk neuromuscular activation was higher in NG compared to EG and this was significant in EO, LSES and ULES in eccentric phase and LSES in the concentric phase. VL activation increased in both phases with no group differences., Conclusion: Trunk neuromuscular activation increases in a fatiguing set of heavy squats regardless of training status. Increased back squat strength through training results in lower neuromuscular activation despite greater absolute external squat loads.