Bilateral Back Extensor Exosuit for multidimensional assistance and prevention of spinal injuries.

Lumbar spine injuries resulting from heavy or repetitive lifting remain a prevalent concern in workplaces. Back-support devices have been developed to mitigate these injuries by aiding workers during lifting tasks. However, existing devices often fall short in providing multidimensional force assistance for asymmetric lifting, an essential feature for practical workplace use. In addition, validation of device safety across the entire human spine has been lacking. This paper introduces the Bilateral Back Extensor Exosuit (BBEX), a robotic back-support device designed to address both functionality and safety concerns. The design of the BBEX draws inspiration from the anatomical characteristics of the human spine and back extensor muscles. Using a multi-degree-of-freedom architecture and serially connected linear actuators, the device's components are strategically arranged to closely mimic the biomechanics of the human spine and back extensor muscles. To establish the efficacy and safety of the BBEX, a series of experiments with human participants was conducted. Eleven healthy male participants engaged in symmetric and asymmetric lifting tasks while wearing the BBEX. The results confirm the ability of the BBEX to provide effective multidimensional force assistance. Moreover, comprehensive safety validation was achieved through analyses of muscle fatigue in the upper and the lower erector spinae muscles, as well as mechanical loading on spinal joints during both lifting scenarios. By seamlessly integrating functionality inspired by human biomechanics with a focus on safety, this study offers a promising solution to address the persistent challenge of preventing lumbar spine injuries in demanding work environments.

Potential of a New, Flexible Electrode sEMG System in Detecting Electromyographic Activation in Low Back Muscles during Clinical Tests: A Pilot Study on Wearables for Pain Management.

BACKGROUND: While low back pain (LBP) is the leading cause of disability worldwide, its clinical objective assessment is currently limited. Part of this syndrome arises from the abnormal sensorimotor control of back muscles, involving increased muscle fatigability (i.e., assessed with the Biering-Sorensen test) and abnormal muscle activation patterns (i.e., the flexion-extension test). Surface electromyography (sEMG) provides objective measures of muscle fatigue development (median frequency drop, MDF) and activation patterns (RMS amplitude change). This study therefore assessed the sensitivity and validity of a novel and flexible sEMG system (NSS) based on PEVA electrodes and potentially embeddable in textiles, as a tool for objective clinical LBP assessment. METHODS: Twelve participants wearing NSS and a commercial laboratory sEMG system (CSS) performed two clinical tests used in LBP assessment (Biering-Sorensen and flexion-extension). Erector spinae muscle activity was recorded at T12-L1 and L4-L5. RESULTS: NSS showed sensitivity to sEMG changes associated with fatigue development and muscle activations during flexion-extension movements (p < 0.05) that were similar to CSS (p > 0.05). Raw signals showed moderate cross-correlations (MDF: 0.60-0.68; RMS: 0.53-0.62). Adding conductive gel to the PEVA electrodes did not influence sEMG signal interpretation (p > 0.05). CONCLUSIONS: This novel sEMG system is promising for assessing electrophysiological indicators of LBP during clinical tests.

The dominance of dorsal scapular artery as the blood supply to muscles of the back in the absence of two primary vessels: a cadaveric case report.

PURPOSE: Understanding of rare or unknown anatomical variations of the vasculature of the neck is critical to reduce the risk of complications during surgeries and other invasive procedures in the neck and shoulder regions. METHODS: Bilateral dissection of the neck and muscles of the back of an 87-year-old Caucasian male donor was performed to demonstrate the origin, course and termination of the arteries that arise in the neck. RESULTS: Several anatomical variations were noted on the right side of the neck of the donor body - (i) only inferior thyroid and ascending cervical arteries originated from the thyrocervical trunk (TCT), from the first part of the subclavian artery (SA), whereas the transverse cervical (TCA) and suprascapular (SSA) arteries were entirely absent, (ii) Dorsal scapular artery (DSA) emerged normally from the third part of the SA. However, after supplying the rhomboids and levator scapulae muscles, DSA provided two additional branches to the trapezius muscle and a branch to the supraspinatus muscle. Interestingly, the branches to the trapezius muscle from the DSA were the only sources of blood supply to the muscle. CONCLUSION: We report a unique anatomical variation involving the absence of the TCA and SSA from the TCT. The unilateral absence of these major vessels and the branches of DSA supplying the trapezius and supraspinatus muscles have not been reported previously in the literature in a single case report. This case study may provide useful information for head and neck reconstruction and shoulder repair surgeries.

Equivalent weight: Application of the assessment method on real task conducted by railway workers wearing a back support exoskeleton.

Commonly used risk indexes, such as the NIOSH Lifting Index, do not capture the effect of exoskeletons. This makes it difficult for Health and Safety professionals to rigorously assess the benefit of such devices. The community requires a simple method to assess the effectiveness of back-support exoskeleton's (BSE) in possibly reducing ergonomic risk. The method introduced in this work is termed "Equivalent Weight" (EqW) and it proposes an interpretation of the effect built on the benefit delivered through reduced activation of the erector spinae (ES). This manifests itself as an apparent reduction of the lifted load perceived by the wearer. This work presents a pilot study where a practical application of the EqW method is used to assess the ergonomic risk in manual material handling (MMH) when using a back support exoskeleton (StreamEXO). The results are assessed by combining observational measurements from on-site testing with five different workers and quantitative measures of the muscle activity reduction achieved during laboratory evaluation with ten workers. These results will show that when lifting, lowering, and carrying a 19 kg load the StreamEXO can reduce risk by up to two levels (from "high" to "low") in the target sub-tasks. The Lifting index (LI) was reduced up to 64% when examining specific sub-tasks and the worker's movement conduction.

Estimation of lower back muscle force in a lifting task using wearable IMUs.

Low back pain is commonly reported in occupational settings due to factors such as heavy lifting and poor ergonomic practices, often resulting in significant healthcare expenses and lowered productivity. Assessment tools for human motion and ergonomic risk at the workplace are still limited. Therefore, this study aimed to assess lower back muscle and joint reaction forces in laboratory conditions using wearable inertial measurement units (IMUs) during weight lifting, a frequently high-risk workplace task. Ten able-bodied participants were instructed to lift a 28 lbs. box while surface electromyography sensors, IMUs, and a camera-based motion capture system recorded their muscle activity and body motion. The data recorded by IMUs and motion capture system were used to estimate lower back muscle and joint reaction forces via musculoskeletal modeling. Lower back muscle patterns matched well with electromyography recordings. The normalized mean absolute differences between muscle forces estimated based on measurements of IMUs and cameras were less than 25 %, and the statistical parametric mapping results indicated no significant difference between the forces estimated by both systems. However, abrupt changes in motion, such as lifting initiation, led to significant differences (p < 0.05) between the muscle forces. Furthermore, the maximum L5-S1 joint reaction force estimated using IMU data was significantly lower (p < 0.05) than those estimated by cameras during weight lifting and lowering. The study showed how kinematic errors from IMUs propagated through the musculoskeletal model and affected the estimations of muscle forces and joint reaction forces. Our findings showed the potential of IMUs for in-field ergonomic risk evaluations.

Biomechanical analysis of different back-supporting exoskeletons regarding musculoskeletal loading during lifting and holding.

Industrial back support exoskeletons (BSEs) are a promising approach to addressing low back pain (LBP) which still affect a significant proportion of the workforce. They aim to reduce lumbar loading, the main biomechanical risk factor for LBP, by providing external support to the lumbar spine. The aim of this study was to determine the supporting effect of one active (A1) and two passive (P1 and P2) BSEs during different manual material handling tasks. Kinematic data and back muscle activity were collected from 12 subjects during dynamic lifting and static holding of 10 kg. Mean and peak L5/S1 extension moments, L5/S1 compression forces and muscle activation were included in the analysis. During dynamic lifting all BSEs reduced peak (12-26 %) and mean (4-17 %) extension moments and peak (10-22 %) and mean (4-15 %) compression forces in the lumbar spine. The peak (13-28 %) and mean (4-32 %) activity of the back extensor muscles was reduced accordingly. In the static holding task, analogous mean reductions for P1 and P2 of L5/S1 extension moments (12-20 %), compression forces (13-23 %) and muscular activity (16-23 %) were found. A1 showed a greater reduction during static holding for extension moments (46 %), compression forces (41 %) and muscular activity (54 %). This pronounced difference in the performance of the BSEs between tasks was attributed to the actuators used by the different BSEs.

Ultrasound imaging of the transversus nuchae muscle: a potential entrapment site for the lesser occipital nerve.

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Myofascial trigger point (MTrP) size and elasticity properties can be used to differentiate characteristics of MTrPs in lower back skeletal muscle.

Myofascial trigger points (MTrPs) are localized contraction knots that develop after muscle overuse or an acute trauma. Significant work has been done to understand, diagnose, and treat MTrPs in order to improve patients suffering from their effects. However, effective non-invasive diagnostic tools are still a missing gap in both understanding and treating MTrPs. Effective treatments for patients suffering from MTrP mediated pain require a means to measure MTrP properties quantitatively and diagnostically both prior to and during intervention. Further, quantitative measurements of MTrPs are often limited by the availability of equipment and training. Here we develop ultrasound (US) based diagnostic metrics that can be used to distinguish the biophysical properties of MTrPs, and show how those metrics can be used by clinicians during patient diagnosis and treatment. We highlight the advantages and limitations of previous US-based approaches that utilize elasticity theory. To overcome these previous limitations, we use a hierarchical approach to distinguish MTrP properties by patients' reported pain and clinician measured palpation. We show how US-based measurements can characterize MTrPs with this approach. We demonstrate that MTrPs tend to be smaller, stiffer, and deeper in the muscle tissue for patients with pain compared to patients without pain. We provide evidence that more than one MTrP within a single US-image field increases the stiffness of neighboring MTrPs. Finally, we highlight a combination of metrics (depth, thickness, and stiffness) that can be used by clinicians to evaluate individual MTrPs in combination with standard clinical assessments.

Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP. METHODS: We conducted a systematic review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach. RESULTS: Nine studies were included in our systematic review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 - 0.81, p < 0.01; I2 = 48 %, p = 0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 - 0.62, p < 0.01; I2 = 39 %, p = 0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory. CONCLUSIONS: Based on the findings of this systematic review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.

Loading Recognition for Lumbar Exoskeleton Based on Multi-Channel Surface Electromyography From Low Back Muscles.

Lumbar exoskeleton is an assistive robot, which can reduce the risk of injury and pain in low back muscles when lifting heavy objects. An important challenge it faces involves enhancing assistance with minimal muscle energy consumption. One of the viable solutions is to adjust the force or torque of assistance in response to changes in the load on the low back muscles. It requires accurate loading recognition, which has yet to yield satisfactory outcomes due to the limitations of available measurement tools and load classification methods. This study aimed to precisely identify muscle loading using a multi-channel surface electromyographic (sEMG) electrode array on the low back muscles, combined with a participant-specific load classification method. Ten healthy participants performed a stoop lifting task with objects of varying weights, while sEMG data was collected from the low back muscles using a 3x7 electrode array. Nineteen time segments of the lifting phase were identified, and time-domain sEMG features were extracted from each segment. Participant-specific classifiers were built using four classification algorithms to determine the object weight in each time segment, and the classification performance was evaluated using a 5-fold cross-validation method. The artificial neural network classifier achieved an impressive accuracy of up to 96%, consistently improving as the lifting phase progressed, peaking towards the end of the lifting movement. This study successfully achieves accurate recognition of load on low back muscles during the object lifting task. The obtained results hold significant potential in effectively reducing muscle energy consumption when wearing a lumbar exoskeleton.

Trunk muscle activation of core stabilization exercises in subjects with and without chronic low back pain.

BACKGROUND: Weakness and atrophy in trunk muscles have been associated with chronic low back pain (CLBP). OBJECTIVE: This study aimed to identify isometric exercises resulting the highest trunk muscle activity for individuals with and without CLBP. METHODS: Fourteen males with CLBP and 15 healthy age-matched healthy subjects were recruited for this study. Muscle activity during maximal voluntary isometric contraction (MVIC) was measured for a comparative reference with surface electromyography (sEMG) from six trunk muscles. Thereafter maximum EMG amplitude values were measured during eleven trunk stability exercises. The maximal EMG activity in each exercise relative to the MVICs was analyzed using generalizing estimating equations (GEE) models with the unstructured correlation structure. RESULTS: The GEE models showed statistically significant differences in muscle activity between exercises within both groups (p< 0.001), with no significant differences between groups (p> 0.05). The highest muscle activity was achieved with the hip flexion machine for multifidus, side pull with a resistance band for lumbar extensors, side and single-arm cable pull exercises for thoracic extensors, rotary plank and the hip flexion machine for abdominal. CONCLUSION: This study found five isometric trunk exercises that exhibited highest muscle activity depending on muscle tested, with no significant difference between individuals with and without CLBP.

Reliability of Ultrasound Shear Wave Elastography for Evaluating Psoas Major and Quadratus Lumborum Stiffness: Gender and Physical Activity Effects.

OBJECTIVE: We aimed to assess the reliability of quantifying psoas major (PM) and quadratus lumborum (QL) stiffness with ultrasound shear wave elastography (SWE), and to explore the effects of gender and physical activity on muscle stiffness. METHODS: Fifty-two healthy participants (18-32 y) were recruited. To determine reliability, 29 of them underwent repeated SWE measurements of PM and QL stiffness by an operator on the same day. The intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence interval (MDC95) were calculated. The rest participants underwent a single measurement. Two-way MANCOVA was conducted for the effects of gender and physical activity on muscle stiffness. RESULTS: The observed reliability for PM (ICC3,1 = 0.89-0.92) and QL (ICC3,1 = 0.79-0.82) were good-to-excellent and good, respectively. The SEM (kPa) was 0.79-1.03 and 1.23-1.28, and the MDC95 (kPa) was 2.20-2.85 and 3.41-3.56 for PM and QL, respectively. After BMI adjustment, both gender (PM: F = 10.15, p = 0.003; QL: F = 18.07, p < 0.001) and activity level (PM: F = 5.90, p = 0.005; QL: F = 6.33, p = 0.004) influenced muscle stiffness. The female and inactive groups exhibited higher stiffness in both muscles. CONCLUSION: SWE is reliable for quantifying the stiffness of PM and QL. Female and physical inactivity may elevate PM and QL stiffness, underscoring the importance of accounting for these factors in muscle stiffness investigations. Larger prospective studies are needed to further elucidate their effects.

Effect Analysis of Wearing an Lumbar Exoskeleton on Coordinated Activities of the Low Back Muscles Using sEMG Topographic Maps.

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.

Low back pain and biomechanical characteristics of back muscles in firefighters.

Firefighters often experience low back pain (LBP), but their back muscle characteristics are not well studied. This study aimed to 1) compare the biomechanical characteristics of back muscles and self-reported back disabilities in frontline firefighters with and without LBP history, and 2) examine the relationships between back disability and biomechanical measurements. We recruited 42 male firefighters and assessed their perceived pain and disabilities, maximum isometric back extension strength, passive stiffness, and fatigability of the longissimus. 54.8% of the participants experienced LBP within the past year. Those indicating higher pain intensity also had greater disability as indicated by the Oswestry Disability Index. There were no significant differences in strength, stiffness or fatigability of the back muscles between firefighters with and without LBP history. Multiple linear regression analysis revealed no significant relationship between the back disability and any biomechanical or demographic measures, likely due to the high functional abilities of the participants.

Approximately 50% of the firefighters who participated in the study experienced low back pain in the past 12 months. Since the pain level was mild to moderate, most of them continued to report to work. Biomechanically, there were no differences in back muscle strength, stiffness, resistance to fatigue, or left-right symmetry between firefighters with and without back pain history. Back disabilities were not related to any biomechanical measures or demographics including age and body mass index. Overall, despite experiencing some back pain, these frontline firefighters are highly functional and did not show diminished physical or neuromuscular responses.

Flexible sensor-based biomechanical evaluation of low-back exoskeleton use in lifting.

This study aimed to establish an ambulatory field-friendly system based on miniaturised wireless flexible sensors for studying the biomechanics of human-exoskeleton interactions. Twelve healthy adults performed symmetric lifting with and without a passive low-back exoskeleton, while their movements were tracked using both a flexible sensor system and a conventional motion capture (MoCap) system synchronously. Novel algorithms were developed to convert the raw acceleration, gyroscope, and biopotential signals from the flexible sensors into kinematic and dynamic measures. Results showed that these measures were highly correlated with those obtained from the MoCap system and discerned the effects of the exoskeleton, including increased peak lumbar flexion, decreased peak hip flexion, and decreased lumbar flexion moment and back muscle activities. The study demonstrated the promise of an integrated flexible sensor-based system for biomechanics and ergonomics field studies as well as the efficacy of exoskeleton in relieving the low-back stress associated with manual lifting.

This study established and tested a flexible sensor-based ambulatory system for biomechanical evaluation of human-exoskeleton interactions and as a promising new tool for field ergonomics studies in practical or naturalistic settings.Abbreviations: MoCap: motion capture; WMSD: Work-related musculoskeletal disorders; EMG: electromyography; IMU: inertial measurement unit; TES: thoracic erector spinae; LES: lumbar erector spinae; WITH: tasks performed with wearing the exoskeleton; WITHOUT: tasks performed without wearing the exoskeleton; RMS: root mean square; RMSE: root-mean-square error; r: Pearson's correlation coefficient; ASIS: anterior superior iliac spine.

Evaluation of the Reproducibility of MR Elastography Measurements of the Lumbar Back Muscles.

BACKGROUND: MR elastography (MRE) may provide quantitative imaging biomarkers of lumbar back muscles (LBMs), complementing MRI in spinal diseases by assessing muscle mechanical properties. However, reproducibility analyses for MRE of LBM are lacking. PURPOSE: To assess technical failure, within-day and inter-day reproducibility, robustness with the excitation source positioning, and inter-observer agreement of MRE of muscles. STUDY TYPE: Prospective. SUBJECTS: Seventeen healthy subjects (mean age 28 ± 4 years; 11 females). FIELD STRENGTH/SEQUENCE: 1.5 T, gradient-echo MRE, T1-weighted turbo spin echo. ASSESSMENT: The pneumatic driver was centered at L3 level. Four MRE were performed during two visits, 2-4 weeks apart, each consisting of two MRE with less than 10 minutes inter-scan interval. At Visit 1, after the first MRE, the coil and driver were removed, then reinstalled. The MRE was repeated. At Visit 2, following the first MRE, only the driver was moved down 5 cm. The MRE was repeated. Two radiologists segmented the multifidus and erector spinae muscles. STATISTICAL TESTS: Paired t-test, analysis of variance, intraclass correlation coefficients (ICCs). P-values <0.05 were considered statistically significant. RESULTS: Mean stiffness of LBM ranged from 1.44 to 1.60 kPa. Mean technical failure rate was 2.5%. Inter-observer agreement was excellent (ICC ranging from 0.82 [0.64-0.96] to 0.99 [0.98-0.99] in the multifidus, and from 0.85 [0.69-0.92] to 0.99 [0.97-0.99] in the erector spinae muscles). Within-day reproducibility was fair in the multifidus (ICC: 0.53 [0.47-0.77]) and good in the erector spinae muscles (ICC: 0.74 [0.48-0.88]). Reproducibility after moving the driver was excellent in both multifidus (ICC: 0.85 [0.69-0.93]) and erector spinae muscles (ICC: 0.84 [0.67-0.92]). Inter-day reproducibility was excellent in the multifidus (ICC: 0.76 [0.48-0.89]) and poor in the erector spinae muscles (ICC: 0.23 [-0.61 to 0.63]). DATA CONCLUSION: MRE of LBM provides measurements of stiffness with fair to excellent reproducibility and excellent inter-observer agreement. However, inter-day reproducibility in the multifidus muscles indicated that the herein used MRE protocol may not be optimal for this muscle. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

Individualized Training of Back Muscles Using Iterative Learning Control of a Compliant Balance Board.

Here we present the GyroTrainer, a bespoke mechatronic balance board system designed to trigger activation of the back muscles while the user engages in a balance-challenging game. The GyroTrainer uses admittance control coupled with an iterative learning approach so as to tailor the admittance control parameters, i.e. difficulty level, according to the user's skill. Our experimental evaluation demonstrated that an individualized admittance control stiffness could be identified for each user, which corresponds with a desired level of difficulty and increased back muscle activity. A first game implementation demonstrates the feasibility of utilizing the GyroTrainer system and the individually identified admittance control stiffness for gamification of back muscle training.

Surface electromyography analysis of core stabilizing muscles during isometric shoulder contractions in athletes with low back pain.

BACKGROUND: The study was carried out in the athletes with and without Low Back Pain (LBP) to determine the surface electromyography activity of core stabilizing muscles while performing isometric shoulder and trunk contractions. STUDY DESIGN: Cross-sectional study. METHODS: This study enlisted the participation of 40 athletes. Group A included 20 athletes (18 males and 2 females) without LBP, and Group B included 20 athletes (12 males and 8 females) with LBP. Athletes with LBP were assessed using the Modified Oswestry Disability Questionnaire (MODQ) and Visual Analog Scale (VAS) to determine their level of disability and pain severity, respectively. EMG activity of the rectus abdominis, external oblique, longissimus, and multifidus was recorded in both groups as they performed bilateral isometric shoulder and trunk contractions. RESULTS: In the LBP group, EMG activity of the rectus abdominis and external oblique muscles was significantly lower (P < 0.05). The LBP group had significantly more multifidus activity (P = 0.03) than the NLBP group. Among all the exercises, bilateral isometric shoulder extension contraction activated the rectus abdominis, right external oblique, and longissimus group of muscles significantly more (P < 0.05) in both groups. In both groups, bilateral isometric shoulder flexion contraction resulted in significantly higher multifidus muscle activation (P = 0.002). CONCLUSION: The activation of core stabilizing muscles was altered in athletes with LBP. When athletes are unable to contract and activate trunk muscles owing to pain, upper extremity exercises can be used to activate these muscles.

Potential of whole-body dual-energy X-ray absorptiometry to predict muscle size of psoas major, gluteus maximus and back muscles.

BACKGROUND: Measurement of trunk muscle cross-sectional area (CSA) using axial magnetic resonance imaging (MRI) is considered clinically meaningful for understanding several spinal pathologies, such as low back pain and spinal sagittal imbalance. However, it remains unclear whether trunk muscle mass (TMM) measured using dual-energy X-ray absorptiometry (DXA) can predict the trunk muscle CSA. The aim of this study is to determine if DXA-derived TMM is associated and predicts with CSA of paraspinal muscles and gluteus maximus measured using MRI in healthy volunteers. METHODS: A total of 48 healthy volunteers underwent whole-body DXA and MRI of the spinopelvic region. The CSA of the psoas major, back muscles, and gluteus maximus were measured on axial MRI. Correlations and linear regressions between the TMM measured using DXA and the CSA of each musculature were investigated. RESULTS: There was a weak correlation between TMM and CSA of the psoas major in men (r = 0.39, P = 0.0678), and the linear regression was y = 301.74x - 401.24 (R2 = 0.2976, P = 0.0070). A moderate correlation was found in women (r = 0.58, P = 0.0021), and the linear regression was y = 230.21x - 695.29 (R2 = 0.4445, P = 0.0003). Moderate correlations were observed between TMM and CSA of the back muscles in both men (r = 0.63, P = 0.0012) and women (r = 0.63, P = 0.0007), the linear regression was y = 468.52x + 3688.5 (R2 = 0.5505, P < 0.0001) in men and y = 477.39x + 2364.1 (R2 = 0.564, P < 0.0001) in women. There was a strong correlation between TMM and CSA of the gluteus maximus in men (r = 0.72, P < 0.0001), and the linear regression was y = 252.69x - 880.5 (R2 = 0.6906, P < 0.0001). A moderate correlation was found in women (r = 0.69, P < 0.0001), and the linear regression was y = 230.74x - 231.32 (R2 = 0.6542, P < 0.0001). CONCLUSIONS: The DXA-derived TMM was able to predict the CSA of the psoas major, back muscles, and gluteus maximus, and significantly correlated with the CSA of the back muscles and gluteus maximus. It might be a safer and cheaper alternative for evaluating the size of the back muscles and gluteus maximus.