Disc size markedly influences concentration profiles of intravenously administered solutes in the intervertebral disc: a computational study on glucosamine as a model solute.

PURPOSE: Tests on animals of different species with large differences in intervertebral disc size are commonly used to investigate the therapeutic efficacy of intravenously injected solutes in the disc. We hypothesize that disc size markedly affects outcome. METHODS: Here, using a small non-metabolized molecule, glucosamine (GL) as a model solute, we calculate the influence of disc size on transport of GL into rat, rabbit, dog and human discs for 10 h post intravenous-injection. We used transient finite element models and considered an identical GL supply for all animals. RESULTS: Huge effects of disc size on GL concentration profiles were found. Post-injection GL concentration in the rat disc reached 70% blood concentration within 15 min but remained below 10% in the human disc nucleus throughout. The GL rapidly penetrated post-injection into smaller discs resulting in homogeneous concentrations. In contrast, GL concentration, albeit at much lower levels, increased with time in the human disc with a small outward flux at the annulus periphery at longer periods. CONCLUSIONS: Changes in the disc size hugely influenced GL concentrations throughout the disc at all regions and times. Increases in administered dose can neither remedy the very low concentration levels in the disc center in larger human disc at early post-injection hours nor alter the substantial differences in concentration profiles estimated among various species. The size effect will only be exacerbated as molecular weight of the solute increases and as the endplate calcifies. Extrapolation of findings from animal to human discs on the efficacy of intravenously administered solutes must proceed with great caution.

Evaluation of ground reaction forces and centers of pressure predicted by AnyBody Modeling System during load reaching/handling activities and effects of the prediction errors on model-estimated spinal loads.

Full-body and lower-extremity human musculoskeletal models require feet ground reaction forces (GRFs) and centers of pressure (CoPs) as inputs to predict muscle forces and joint loads. GRFs/CoPs are traditionally measured via floor-mounted forceplates that are usually restricted to research laboratories thus limiting their applicability in real occupational and clinical setups. Alternatively, GRFs/CoPs can be estimated via inverse dynamic approaches as also implemented in the Anybody Modeling System (AnyBody Technology, Aalborg, Denmark). The accuracy of Anybody in estimating GRFs/CoPs during load-handling/reaching activities and the effect of its prediction errors on model-estimated spinal loads remain to be investigated. Twelve normal- and over-weight individuals performed total of 480 static load-handling/reaching activities while measuring (by forceplates) and predicting (by AnyBody) their GRFs/CoPs. Moreover, the effects of GRF/CoP prediction errors on the estimated spinal loads were evaluated by inputting measured or predicted GRFs/CoPs into subject-specific musculoskeletal models. Regardless of the subject groups (normal-weight or overweight) and tasks (load-reaching or load-handling), results indicated great agreements between the measured and predicted GRFs (normalized root-mean-squared error, nRMSEs < 14% and R2 > 0.90) and between their model-estimated spinal loads (nRMSEs < 14% and R2 > 0.83). These agreements were good but relatively less satisfactory for CoPs (nRMSEs < 17% and 0.57 < R2 < 0.68). The only exception, requiring a more throughout investigation, was the situation when the ground-foot contact was significantly reduced during the activity. It appears that occupational/clinical investigations performed in real workstation/clinical setups with no access to forceplates may benefit from the AnyBody GRF/CoP prediction tools for a wide range of load-reaching/handling activities.

Effect of obesity on spinal loads during load-reaching activities: A subject- and kinematics-specific musculoskeletal modeling approach.

Obesity has been associated to increase the risk of low back disorders. Previous musculoskeletal models simulating the effect of body weight on intervertebral joint loads have assumed identical body postures for obese and normal-weight individuals during a given physical activity. Our recent kinematic-measurement studies, however, indicate that obese individuals adapt different body postures (segmental orientations) than normal-weight ones when performing load-reaching activities. The present study, therefore, used a subject- and kinematics-specific musculoskeletal modeling approach to compare spinal loads of nine normal-weight and nine obese individuals each performing twelve static two-handed load-reaching activities at different hand heights, anterior distances, and asymmetry angles (total of 12 tasks × 18 subjects = 216 model simulations). Each model incorporated personalized muscle architectures, body mass distributions, and full-body kinematics for each subject and task. Results indicated that even when accounting for subject-specific body kinematics obese individuals experienced significantly larger (by âˆ¼38% in average) L5-S1 compression (2305 ± 468 N versus 1674 ± 337 N) and shear (508 ± 111 N versus 705 ± 150 N) loads during all reaching activities (p < 0.05 for all hand positions). This average difference of âˆ¼38% was similar to the results obtained from previous modeling investigations that neglected kinematics differences between the two weight groups. Moreover, there was no significant interaction effect between body weight and hand position on the spinal loads; indicating that the effect of body weight on L5-S1 loads was not dependent on the position of hands. Postural differences alone appear, hence, ineffective in compensating the greater spinal loads that obese people experience during reaching activities.

Reliability and validity of the Persian version of Foot and Ankle Ability Measure (FAAM) to measure functional limitations in patients with foot and ankle disorders.

OBJECTIVE: To translate the Foot and Ankle Ability Measure (FAAM) into Persian and to evaluate the psychometric properties of the Persian version of FAAM. METHODS: 93 patients with a range of foot and ankle disorders, completed the Persian version of the FAAM and Short-Form 36 Health Survey (SF-36) in the test session. With an interval of 2-6 days, 60 patients filled out the FAAM in the retest session. The FAAM is composed of two subscales including activities of daily living (ADL) and SPORTS. Internal consistency was assessed using Cronbach's alpha, test-retest reliability using intraclass correlation coefficient (ICC) and standard error of measurement (s.e.m.), item internal consistency and discriminant validity using Spearman's correlation coefficient and construct validity using Spearman's correlation coefficient and Independent t-test. RESULTS: Cronbach's alpha coefficient of 0.97 and 0.94 was obtained for ADL and SPORTS subscales, respectively. The ICC and s.e.m. were 0.98 and 3.13 for ADL and 0.98 and 3.53 for SPORTS subscale. Items were stronger measures of their hypothesized subscale than of other subscale. The ADL and SPORTS subscales had stronger correlation with SF-36 physical function (r=0.60, 0.53) and physical health summary measure (r=0.61, 0.48) than with SF-36 mental health (r=0.21, 0.10) and mental health summary measure (r=0.36, 0.27). A high correlation was found between FAAM scores and global scale of functional status for SPORTS (r=0.73) but not for ADL (r=0.42). FAAM scores were greater in individuals who rated their function as normal or nearly normal compared with those who rated as abnormal or severely abnormal for SPORTS (P=0.04) but not for ADL (P=0.15). CONCLUSION: The Persian version of FAAM is a reliable and valid measure to quantify physical functioning in patients with foot and ankle disorders.

How does the central nervous system address the kinetic redundancy in the lumbar spine? Three-dimensional isometric exertions with 18 Hill-model-based muscle fascicles at the L4-L5 level.

The human motor system is organized for execution of various motor tasks in a different and flexible manner. The kinetic redundancy in the human musculoskeletal system is a significant property by which the central nervous system achieves many complementary goals. An equilibrium-based biomechanical model of isometric three-dimensional exertions of trunk muscles has been developed. Following the definition and role of the uncontrolled manifold, the kinetic redundancy concept is explored in mathematical terms. The null space of the kinetically redundant system when a certain joint moment and/or stiffness are needed is derived and discussed. The aforementioned concepts have been illustrated, using a three-dimensional three-degrees-of-freedom biomechanical model of the spine with 18 anatomically oriented Hill-type-model muscle fascicles. The considerations of stability and its consequence on the internal loading of the spine and coactivation consequences are discussed in both general and specific cases. The results can shed light on the interaction mechanisms in muscle activation patterns seen in various tasks and exertions and can provide a significant understanding for future research studies and clinical practices related to low-back disorders. Alteration of recruitment patterns in low-back-pain patients has been explained on the basis of this biomechanical analysis. The higher coactivation results in higher internal loading while providing higher joint stiffness that enhances spinal stability, which guards against spinal deformation in the presence of any perturbations.

Design and evaluation of a novel triaxial isometric trunk muscle strength measurement system.

Maximal strength measurements of the trunk have been used to evaluate the maximum functional capacity of muscles and the potential mechanical overload or overuse of the lumbar spine tissues in order to estimate the risk of developing musculoskeletal injuries. A new triaxial isometric trunk strength measurement system was designed and developed in the present study, and its reliability and performance was investigated. The system consisted of three main revolute joints, equipped with torque sensors, which intersect at L5-S1 and adjustment facilities to fit the body anthropometry and to accommodate both symmetric and asymmetric postures in both seated and standing positions. The dynamics of the system was formulated to resolve validly the moment generated by trunk muscles in the three anatomic planes. The optimal gain and offset of the system were obtained using deadweights based on the least-squares linear regression analysis. The R2 results of calibration for all loading courses of all joints were higher than 0.99, which indicated an excellent linear correlation. The results of the validation analysis of the regression model suggested that the mean absolute error and the r.m.s. error were less than 2 per cent of the applied load. The maximum value of the minimum detectable change was found to be 1.63 Nm for the sagittal plane torque measurement, 0.8 per cent of the full-scale load. The trial-to-trial variability analysis of the device using deadweights provided intra-class correlation coefficients of higher than 0.99, suggesting excellent reliability. The cross-talk analysis of the device indicated maximum cross-talks of 1.7 per cent and 3.4 per cent when the system was subjected to flexion-extension and lateral bending torques respectively. The trial-to-trial variability of the system during in-vivo strength measurement tests resulted in good to excellent reliability, with intra-class correlation coefficients ranging from 0.69 to 0.91. The results of the maximum voluntary isometric torques exertion measurements for 30 subjects indicated good agreement with the previously published data in the literature. The extensive capabilities and high reliability of the system are promising for more comprehensive investigations on the trunk biomechanics in future, e.g. isometric strength measurement at symmetric and asymmetric postures, muscle endurance, and recruitment pattern analysis.

Trunk biomechanics during maximum isometric axial torque exertions in upright standing.

BACKGROUND: Activities involving axial trunk rotations/moments are common and are considered as risk factors for low back disorders. Previous biomechanical models have failed to accurately estimate the trunk maximal axial torque exertion. Moreover, the trunk stability under maximal torque exertions has not been investigated. METHODS: A nonlinear thoracolumbar finite element model along with the Kinematics-driven approach is used to study biomechanics of maximal axial torque generation during upright standing posture. Detailed anatomy of trunk muscles with six distinct fascicles for each abdominal oblique muscle on each side is considered. While simulating an in vivo study of maximal axial torque exertion, effects of antagonistic coactivities, coupled moments and maximum muscle stress on results are investigated. FINDINGS: Predictions for trunk axial torque strength and relative muscle activities compared well with reported measurements. Trunk strength in axial torque was only slightly influenced by variations in coupled moments. Presence of abdominal antagonistic coactivities and alterations in maximum strength of muscles had, however, greater effect on maximal torque exertion. Abdominal oblique muscles play crucial role in generating moments in all three planes while back muscles are mainly effective in balancing moments in sagittal/coronal planes. Trunk stability is not of a concern in maximum axial torque exertions nor is it improved by antagonistic abdominal coactivities. INTERPRETATION: In contrast to previous biomechanical model studies, the Kinematics-driven approach accurately predicts the trunk response in maximal isometric axial torque exertions by taking into account detailed anatomy of abdominal oblique muscles while satisfying equilibrium requirements in all planes/directions. In maximal torque exertions, the spine is at much higher risk of tissue injury due to large segmental loads than of instability.

Relative efficiency of abdominal muscles in spine stability.

Using an iterative kinematics-driven nonlinear finite element model, relative efficiency of individual abdominal muscles in spinal stability in upright standing posture was investigated. Effect of load height on stability and muscle activities was also computed under different coactivity levels in abdominal muscles. The internal oblique was the most efficient muscle (compared with the external oblique and rectus abdominus) in providing stability while generating smaller spinal loads with lower fatigue rate of muscles. As the weight was held higher, stability deteriorated requiring additional flexor-extensor activities. The stabilising efficacy of abdominal muscles diminished at higher activities. The difference in critical loads in frontal and sagittal planes computed in the absence of abdominal coactivity disappeared under prescribed coactivities suggesting an optimal system in stability. The central nervous system may settle for a less stable spine in favour of lowering the risk of injury. Findings could help introduce stability criterion in optimisation models.

Dynamic iso-resistive trunk extension simulation: contributions of the intrinsic and reflexive mechanisms to spinal stability.

The effects of external resistance on the recruitment of trunk muscles and the role of intrinsic and reflexive mechanisms to ensure the spinal stability are significant issues in spinal biomechanics. A computational model of spine under the control of 48 anatomically oriented muscle actions was used to simulate iso-resistive trunk movements. Neural excitation of muscles was attained based on inverse dynamics approach along with the stability-based optimization. The effect of muscle spindle reflex response on the trunk movement stability was evaluated upon the application of a perturbation moment. In this study, the trunk extension movement at various resistance levels while extending from 60 degrees flexion to the upright posture was investigated. Incorporation of the stability condition as an additional constraint in the optimization algorithm increased antagonistic activities for all resistance levels demonstrating that the co-activation caused an increase in the intrinsic stiffness of the spine and its stability in a feed-forward manner. During the acceleration phase of the movement, extensors activity increased while flexors activity decreased in response to the higher resistance. The co-activation ratio noticed in the braking phase of the movement increased with higher resistance. In presence of a 30 Nm flexion perturbation moment, reflexive feed-back noticeably decreased the induced deviation of the velocity and position profiles from the desired ones at all resistance levels. The stability-generated co-activation decreased the reflexive response of muscle spindles to the perturbation demonstrating that both intrinsic and reflexive mechanisms contribute to the trunk stability. The rise in muscle co-activation can ameliorate the corruption of afferent neural sensory system at the expense of higher loading of the spine.

The effect of parameters of equilibrium-based 3-D biomechanical models on extracted muscle synergies during isometric lumbar exertion.

A hallmark of more advanced models is their higher details of trunk muscles represented by a larger number of muscles. The question is if in reality we control these muscles individually as independent agents or we control groups of them called "synergy". To address this, we employed a 3-D biomechanical model of the spine with 18 trunk muscles that satisfied equilibrium conditions at L4/5, with different cost functions. The solutions of several 2-D and 3-D tasks were arranged in a data matrix and the synergies were computed by using non-negative matrix factorization (NMF) algorithms. Variance accounted for (VAF) was used to evaluate the number of synergies that emerged by the analysis, which were used to reconstruct the original muscle activations. It was showed that four and six muscle synergies were adequate to reconstruct the input data of 2-D and 3-D torque space analysis. The synergies were different by choosing alternative cost functions as expected. The constraints affected the extracted muscle synergies, particularly muscles that participated in more than one functional tasks were influenced substantially. The compositions of extracted muscle synergies were in agreement with experimental studies on healthy participants. The following computational methods show that the synergies can reduce the complexity of load distributions and allow reduced dimensional space to be used in clinical settings.

Functional roles of abdominal and back muscles during isometric axial rotation of the trunk.

Electromyographic (EMG) studies have shown that a large number of trunk muscles are recruited during axial rotation. The functional roles of these trunk muscles in axial rotation are multiple and have not been well investigated. In addition, there is no information on the coupling torque at different exertion levels during axial rotation. The aim of the study was to investigate the functional roles of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum and multifidus during isometric right and left axial rotation at 100%, 70%, 50% and 30% maximum voluntary contractions (MVC) in a standing position. The coupling torques in sagittal and coronal planes were measured during axial rotation to examine the coupling nature of torque at different levels of exertions. Results showed that the coupled sagittal torque switches from nil to flexion at maximum exertion of axial rotation. Generally, higher EMG activities were shown at higher exertion levels for all the trunk muscles. Significant differences in activity between the right and left axial rotation exertions were demonstrated in external oblique, internal oblique, latissimus dorsi and iliocostalis lumborum while no difference was shown in rectus abdominis and multifidus. These results demonstrated the different functional roles of trunk muscles during axial rotation. This is important considering that the abdominal and back muscles not only produce torque but also maintain the spinal posture and stability during axial rotation exertions. The changing coupling torque direction in the sagittal plane when submaximal to maximal exertions were compared may indicate the complex nature of the kinetic coupling of trunk muscles.

Comparison of methods for the calculation of energy storage and return in a dynamic elastic response prosthesis.

The standard method used to calculate the ankle joint power contains deficiencies when applied to dynamic elastic response prosthetic feet. The standard model, using rotational power and inverse dynamics, assumes a fixed joint center and cannot account for energy storage, dissipation, and return. This study compared the standard method with new analysis models. First, assumptions of inverse dynamics were avoided by directly measuring ankle forces and moments. Second, the ankle center of rotation was corrected by including translational power terms. Analysis with below-knee amputees revealed that the conventional method overestimates ankle forces and moments as well as prosthesis energy storage and return. Results for efficiency of energy return were varied. Large differences between models indicate the standard method may have serious inadequacies in the analysis of certain prosthetic feet. This research is the first application of the new models to prosthetic feet, and suggests the need for additional research in gait analysis with energy-storing prostheses.

A method for measuring external spinal loads during unconstrained free-dynamic lifting.

Biomechanical lifting models often require the knowledge of the applied trunk moments and forces for model validation purposes and/or to determine loading levels experienced at various joints of the body. Trunk kinetic data under dynamic exertions are commonly difficult to attain without restrictive anatomic/anthropometric assumptions and cost or constraining body motion. The main objectives of the study were to present a new technique for determining continuous three-dimensional forces and moments about the L5/S1 spinal joint, and to validate the technique and assess its applicability under lifting situations. A combination of a force plate and two electrogoniometers facilitated the determination of trunk kinetics about L5/S1. An apparatus was devised to allow the application of various actual moments that were compared to their corresponding predicted moments. The results showed that, over all the conditions considered, the average percent error in estimating the actual applied moment(s) was about 4% (2.3 S.D.), with a test-retest reliability approaching unity. Given such agreement, along with the relative ease and directness of the method, it is believed that this approach should be applicable under most lifting conditions. The technique offers a fairly accurate measure of trunk moments without the need for constraining the motion of any body joint.

Stability and a control strategy of a multilink musculoskeletal model with applications in FES.

This paper introduces a relegated control strategy for point-to-point movement of musculoskeletal systems driven by redundant actuators. The actuator system is partitioned to two functional groupings referred to as gravity compensators and movement generators. Unlike dynamic optimization methods, relegation of control enables real-time computation of control signals to the muscle actuators. It is shown that this strategy significantly reduces the degree of coactivation needed to stabilize the movement. The real-time nature of this strategy coupled with reduced coactivation makes the proposed strategy amenable for multichannel control of parapalegics through functional electrical stimulation. Stimulations of a three-link sagittal system are conducted to test the algorithm for a bowing movement.

The relationship of torque, velocity, and power with constant resistive load during sagittal trunk movement.

Strength and fitness studies have been used to determine the predictability of back pain episodes. Tests have demonstrated that isometric strength displays little prognostic value in the development of low-back pain. Static isometric tests have achieved widespread usage due to the simplicity and safety of protocols, the readily available technology, and the low administrative costs. Dynamic lifting models have, however, predicted significantly higher spinal loads than those derived from static models. The objectives of this study were twofold: to investigate the relationship of the torque, velocity, and power to the resistive load during trunk flexion and extension, and to develop predictive models for these relationships for the subject's performance of the 10th, 50th, and 90th percentile distribution. The results of the study found that the flexion/extension torque had a positive linear correlation with the set resistance; the velocity displayed a negative linear correlation, while power had a quadratic relationship with the resistance.

Estimation of trunk muscle forces and spinal loads during fatiguing repetitive trunk exertions.

STUDY DESIGN: The effects of human trunk extensor muscle fatigue on the estimated trunk muscle forces and spinal loading were investigated during the performance of repetitive dynamic trunk extension. OBJECTIVE: To evaluate if alterations in the trunk muscle recruitment patterns resulted in a greater estimated active loading of the spine and, in turn, an increased risk of injury. SUMMARY OF BACKGROUND DATA: Epidemiologic studies highlight the increased risk of low back injury during repetitive lifting, implicating fatigue of muscles and/or passive tissues as causes of such injury. Increased trunk muscle activity or altered recruitment patterns resulting from fatigue in the primary trunk extensor muscles may indicate an increase in the active loading of the spine, which could contribute to an increased risk of injury. METHODS: Sixteen healthy study participants performed repetitive isokinetic trunk extension endurance tests at two load levels and two repetition rates, while their net muscular torque output and trunk muscular activity were measured. During each exertion, trunk torque, position, and velocity were controlled, so that any change in muscle activity could be attributed to fatigue. An electromyography-assisted model, adapted to accommodate the decline in maximum muscular tension generation resulting from fatigue, was used to estimate the 10 trunk muscle forces and spinal loading. Linear regression was used to quantify the rate of change in muscle force and spinal loading resulting from fatigue, while analysis of variance was used to determine if the rate of change was dependent on the task conditions (load and repetition rate). RESULTS: Significant elevations were estimated for the latissimus dorsi and external oblique muscle forces in more than 70% of the endurance tests, whereas significant reductions in the erector spinae muscle force were predicted in 75% of the trials. The magnitude of the range of change of the erector spinae and latissimus dorsi muscle forces was dependent on the load level and repetition rate. The reduction in erector spinae forces offset the augmented force in the other muscles, because the net changes in compression and lateral shear forces on the spine were not significant, and the anteroposterior shear was reduced. CONCLUSION: The results of the study do not suggest that an increase in the muscular loading of the spine occurs as a result of changing trunk muscular recruitment patterns. Therefore, future studies should focus on injury mechanisms that may occur as a result of a change in the viscoelastic passive tissue responses, muscular insufficiency, or a decline in neuromuscular control and coordination.

Nonlinear response analysis of the human ligamentous lumbar spine in compression. On mechanisms affecting the postural stability.

Basic questions regarding how extreme compressive loads can be tolerated by the spine without experiencing abnormal motions or instabilities remain unresolved. Two finite element models of the human lumbar spine were generated. The detailed model accounted for the three-dimensional irregular geometry, material and geometric nonlinearities, nonhomogeneous fiber-matrix nature of the discs, ligaments, and articulation at the facet joints. The nonlinear stability response of the model was predicted under an axial compression force (200 N to 700 N) applied at the L1 while the S1 was fixed. The effect of the presence of a combined flexion moment and a horizontal support on the response was investigated. Another nonlinear model using rigid bodies interconnected by deformable beam elements was also considered. The computed results under the axial compression loads indicated that the response is highly nonlinear with no bifurcation or limit point (critical load). The unconstrained lumbar spine is most flexible in the sagittal plane (least stiff plane). The existence of the horizontal support and the combined flexion moment significantly increased the load-bearing capacity of the lumbar spine; the lumbar spine resisted the axial compression force of 400 N with minimal displacements. Under axial compression force, the flexion moment tends to restrict the posterior translational movement of the lordotic lumbar spine, whereas the horizontal support constrains the coupled lateral motion. A slight decrease in the lordosis was predicted for the compression load of 400 N. It is postulated that the anterior location of the line of gravity of the upper-body weight is regulated to provide the required combined loads on the lumbar spine so higher compression can be tolerated by the spine at minimal energetic cost. In vivo experimental results support the validity of the model predictions.

A database of isoinertial trunk strength tests against three resistance levels in sagittal, frontal, and transverse planes in normal male subjects.

Spatial joint complexes, such as the spine, require multiaxial systems to adequately assess their functional capacity. The B200 Isostation (Isotechnologies, Inc., Carrboro, North Carolina) is a triaxial system that has three hydraulic pumps under control of an IBM-XT. The transducers measure the torque, angular position, and velocity for all axes simultaneously. There is no isoinertial data base available for strength at different resistances in the sagittal, coronal, and transverse planes. A normal data base for dynamic performance against resistances equal to 30%, 50%, and 70% of the maximum isometric strength of trunk muscles in all three planes was established.

The role of complex, simultaneous trunk motions in the risk of occupation-related low back disorders.

STUDY DESIGN: Simultaneous trunk kinematic variables of industrial workers performing jobs with varying degrees of low back disorder risk were quantified, by using a three-dimensional electrogoniometer. OBJECTIVES: To assess the distinguishing patterns of simultaneous multidimensional (complex) motion parameters of workers performing manual material handling jobs with varying degrees of low back disorder risk. SUMMARY OF BACKGROUND DATA: There is significant epidemiologic and biomechanical evidence that implicates simultaneously occurring or combined motions and loading as important risk factors follow back disorder. However, the specific levels or magnitudes and patterns of these complex motions at which risk of low back disorder is increased are still unknown. METHODS: An industrial database of 126 workers and jobs was used to quantify the complex trunk motions of groups with varying degrees of low back disorder risk. Three groups, low-, medium-, and high-risk, were defined on the basis of retrospective injury records of the corresponding jobs. The jobs were further classified into five cells of weight-lift rate combinations. Within each weight-lift rate cell, the three-dimensional trunk motion patterns of workers were analyzed. Bivariate distributions and cumulative distribution functions were used to compare the simultaneous occurrence of complex dynamic motions among risk groups. RESULTS: High- and medium-risk groups exhibited complex trunk motion patterns involving high magnitudes of combined velocities, especially at extreme sagittal flexion; whereas the low-risk group did not. Postural trunk information alone did not provide a consistent pattern of distinguishing among risk groups. CONCLUSIONS: Elevated levels of complex simultaneous velocity patterns were unique to groups with increased low back disorder risk. Knowledge of these complex trunk velocity patterns in combination with key workplace factors provides a more sensitive means for identifying low back disorder occupational risk factors than does mere postural information.

An assessment of complex spinal loads during dynamic lifting tasks.

STUDY DESIGN: An electromyogram-assisted free-dynamic lifting model was used to quantify the patterns of complex spinal loads in subjects performing various lifting tasks. OBJECTIVES: To assess in vivo the three-dimensional complex spinal loading patterns associated with high and low risk lifting conditions that matched those observed in industrial settings. SUMMARY OF BACKGROUND DATA: Combined loading on the spine has been implicated as a major risk factor in occupational low back disorders. However, there is a void in the literature regarding the role of these simultaneously occurring complex spinal loads during manual lifting. METHODS: Eleven male subjects performed symmetric and asymmetric lifting tasks with varying speed and weight. Reactive forces and moments at L5-S1 were determined through the use of electrogoniometers and a force plate. An electromyogram-assisted model provided the continuous patterns of three-dimensional spinal loads under these complex lifting tasks. RESULTS: The results showed that complex dynamic motions similar to those observed in risky industrial tasks generated substantial levels of combined compressive and shear loads. In addition, higher loading rates were observed under these conditions. Unlike loading magnitudes, loading rate was a better indicator of dynamic loading because it incorporated both the duration and magnitude of net muscle forces contributing to total spinal loading during the lifting conditions. CONCLUSIONS: Quantification of spinal combined motions and loading in vivo has not been undertaken. This study provided a unified assessment of the effects of combined or coupled motions and moments in the internal loading of the spine. Dynamic lifting conditions similar to those observed in risky industrial situations generated unique complex patterns of spinal loading, which have been implicated to pose a higher risk to the spinal structure. The higher predicted loading and loading rate during asymmetric lifting conditions can be avoided by appropriate ergonomic workplace modifications.