Can training to dissociate trunk and pelvic motion influence thorax-pelvis coordination and lumbar spine dynamic stability?

BACKGROUND: The large number of articulating joints within the spinal column provides an abundance of options to control its movement. However, the ability of individuals to consciously manipulate these movement options is poorly understood. OBJECTIVES: To determine if short-term training can improve the ability to consciously dissociate motion between the pelvis and thorax during repetitive pelvic tilting movements. DESIGN: Cross-over design with young healthy individuals. METHOD: Seventeen participants performed trials consisting of 35 continuous lift/lowers followed by 35 continuous anterior/posterior pelvic tilts while spine kinematics were recorded. Participants then underwent a 20-min training protocol designed to improve the control of pelvic motion and in particular the dissociation of pelvic and trunk motion. Post-training, the continuous pelvic tilt and lift/lower trials were repeated. Thorax-pelvis movement coordination was analyzed via vector coding and lumbar spine local dynamic stability was analyzed via Lyapunov exponents. Participants were grouped as being either high or low skill movers based on their ability to perform the pre-training pelvic tilt movements. RESULTS: The low skill movement group demonstrated statistically significant increases in the time spent using in-phase pelvic dominant (p = 0.028) and anti-phase pelvic dominant (p = 0.043) coordination patterns during the pelvic tilt movements after the completion of the training protocol. The high skill movement group showed no differences in their movement patterns post-training. CONCLUSIONS: Short-term training, targeted to improve the ability to dissociate pelvic from thorax motion, had a beneficial effect on the group of individuals who initially lacked skill performing the pelvic tilting task.

Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis.

INTRODUCTION: Sitting on an unstable surface is a common paradigm to investigate trunk postural control among individuals with low back pain (LBP), by minimizing the influence lower extremities on balance control. Outcomes of many small studies are inconsistent (e.g., some find differences between groups while others do not), potentially due to confounding factors such as age, sex, body mass index [BMI], or clinical presentations. We conducted a systematic review with an individual participant data (IPD) meta-analysis to investigate whether trunk postural control differs between those with and without LBP, and whether the difference between groups is impacted by vision and potential confounding factors. METHODS: We completed this review according to PRISMA-IPD guidelines. The literature was screened (up to 7th September 2023) from five electronic databases: MEDLINE, CINAHL, Embase, Scopus, and Web of Science Core Collection. Outcome measures were extracted that describe unstable seat movements, specifically centre of pressure or seat angle. Our main analyses included: 1) a two-stage IPD meta-analysis to assess the difference between groups and their interaction with age, sex, BMI, and vision on trunk postural control; 2) and a two-stage IPD meta-regression to determine the effects of LBP clinical features (pain intensity, disability, pain catastrophizing, and fear-avoidance beliefs) on trunk postural control. RESULTS: Forty studies (1,821 participants) were included for the descriptive analysis and 24 studies (1,050 participants) were included for the IPD analysis. IPD meta-analyses revealed three main findings: (a) trunk postural control was worse (higher root mean square displacement [RMSdispl], range, and long-term diffusion; lower mean power frequency) among individuals with than without LBP; (b) trunk postural control deteriorated more (higher RMSdispl, short- and long-term diffusion) among individuals with than without LBP when vision was removed; and (c) older age and higher BMI had greater adverse impacts on trunk postural control (higher short-term diffusion; longer time and distance coordinates of the critical point) among individuals with than without LBP. IPD meta-regressions indicated no associations between the limited LBP clinical features that could be considered and trunk postural control. CONCLUSION: Trunk postural control appears to be inferior among individuals with LBP, which was indicated by increased seat movements and some evidence of trunk stiffening. These findings are likely explained by delayed or less accurate corrective responses. SYSTEMATIC REVIEW REGISTRATION: This review has been registered in PROSPERO (registration number: CRD42021124658).

Exploring how metronome pacing at varying movement speeds influences local dynamic stability and coordination variability of lumbar spine motion during repetitive lifting.

Auditory metronomes have been used to preserve movement consistency when examining local dynamic stability (LDS) and coordination variability (CV) of lumbar spine motion during repetitive movements. However, the potential influence of the metronome itself on these outcome measures has rarely been considered. Therefore, this study investigated the influence of different metronome paces (i.e., lifting speeds) on measures of lumbar spine LDS and thorax-pelvis CV during a repetitive lifting/lowering task in comparison to self-paced movements. Ten participants completed 5 repetitive lift/lower trials, where participants completed 35 consecutive repetitions (analysis on last 30 repetitions) at a self-selected pace for the first and last trial, and were paced by a 10 lift/min, 15 lift/min, and 20 lift/min metronome, in randomized order, for the remaining three trials. The average self-paced lift/lower speed before and after experiencing the three different metronome paced speeds was 16.2 (±1.02) and 17.2 (±0.73) lifts/min, respectively, and the most-preferred metronome pace trial was 15 lifts/min. Thorax-pelvis CV during the self-paced trials were similar (p > 0.05) to the 15 lift/min metronome paced trials, while greater thorax-pelvis CV was observed for the 10 lift/min compared to the 15 lift/min and 20 lift/min and second self-paced trial (all p < 0.026). This movement speed effect was not observed for lumbar spine LDS; however, more-dynamically stable movements were observed during all metronome paced trials in comparison to the self-paced trials. This study highlights that careful consideration is required when employing a metronome to control/manipulate movement characteristics while examining neuromuscular control using non-linear dynamical systems measures.

Non-invasive assessment of sacroiliac joint and lumbar spine positioning in different unilateral sitting postures.

BACKGROUND: Sacroiliac joint (SIJ) motion has been documented using invasive and noninvasive kinematic techniques. No study has explored SIJ angular positions in functional postures using noninvasive techniques. The purpose of this study was to quantify SIJ positioning among different seated postures in a healthy population. METHODS: Twelve female and 11 male healthy young participants participated. Left and right anterior and posterior superior iliac spines were manually digitized during standing, neutral sitting and four different seated postures. Rigid bodies recorded the kinematics of the lumbar spine. Angles calculated included transverse sacroiliac angle, innominate sagittal angle, sacral tilt, lumbar flexion-extension, lumbar lateral bend and lumbar axial twist. FINDINGS: The observed range of angular positions was approximately 3 to 4 degrees across the SIJ-related angles. The main effect of seated posture was observed for all angles measured. The main effect of sex was observed for all angles except lumbar lateral bending. Females consistently experienced more posterior sacral tilt than males. Interaction effects between sex and posture were only observed at the right-transverse sacroiliac angle and sacral tilt. Previous sitting posture affected the subsequent neutral sitting posture for the right-transverse sacroiliac angle and lumbar spine angle. INTERPRETATION: SIJ angular position differences among the seated postures were similar in magnitude to motions previously reported in participants undergoing prone passive hip abduction and external rotation. Sex differences, including greater sacral posterior tilt observed in females, likely reflect underlying morphological and physiological differences. Future studies should explore SIJ positioning during functional tasks in pathological populations to help elucidate the underlying causes of SIJ pain and inform treatment strategies.

Experience influences kinematic motor synergies: an Uncontrolled manifold approach to simulated Nordic skiing.

Motor synergies are defined as central nervous system mechanisms which adjust participating degrees of freedom to ensure dynamic stability (control) of certain performance variables and have been identified during many motor tasks. The potential for synergistic control of individual segments during full-body tasks is often overlooked. Thus, this study compared individual differences in the potential stabilization of multiple performance variables on the basis of experience during a full-body sport activity. Normalized time series of synergy indices from Uncontrolled Manifold analyses on experienced (n = 9) and inexperienced (n = 19) participants were analysed using statistical parametric mapping during simulated Nordic skiing. Regardless of experience, hand, upper arm, and whole-body centre of mass (COM) kinematics were found to be stabilized by kinematic motor synergies. Only experienced Nordic skiers stabilized trunk COM position at all, while trunk COM velocity was stabilized for a longer duration than inexperienced participants. However, inexperienced participants stabilized hand velocity for a greater duration overall and to a greater magnitude during early pull phase than the experienced skiers. That motor synergies for hand and trunk COM velocity differed between experience groups suggests potential utility for these performance variables as indicators of motor skill development for full-body tasks such as Nordic skiing.

Glycerol induced paraspinal muscle degeneration leads to hyper-kyphotic spinal deformity in wild-type mice.

Degenerative spinal disorders, including kyphotic deformity, are associated with a range of degenerative characteristics of the paraspinal musculature. It has therefore been hypothesized that paraspinal muscular dysfunction is a causative factor for degenerative spinal deformity; however, experimental studies demonstrating causative relationships are lacking. Male and female mice received either glycerol or saline injections bilaterally along the length of the paraspinal muscles at four timepoints, each separated by 2 weeks. Immediately after sacrifice, micro-CT was performed to measure spinal deformity; paraspinal muscle biopsies were taken to measure active, passive and structural properties; and lumbar spines were fixed for analysis of intervertebral disc (IVD) degeneration. Glycerol-injected mice demonstrated clear signs of paraspinal muscle degeneration and dysfunction: significantly (p < 0.01) greater collagen content, lower density, lower absolute active force, greater passive stiffness compared to saline-injected mice. Further, glycerol-injected mice exhibited spinal deformity: significantly (p < 0.01) greater kyphotic angle than saline-injected mice. Glycerol-injected mice also demonstrated a significantly (p < 0.01) greater IVD degenerative score (although mild) at the upper-most lumbar level compared to saline-injected mice. These findings provide direct evidence that combined morphological (fibrosis) and functional (actively weaker and passively stiffer) alterations to the paraspinal muscles can lead to negative changes and deformity within the thoracolumbar spine.

The Effects of Posture and Dynamic Stretching on the Electromechanical Delay of the Paraspinal Muscles.

Electromechanical delay (EMD) of muscle is influenced in part by its in-series arrangement with connective tissue. Therefore, studying EMD might provide a better understanding of the muscle-connective tissue interaction. Here, EMD of the thoracic and lumbar erector spinae muscles were investigated under conditions that could influence muscle-connective tissue interaction. A total of 19 participants performed isometric back extension contractions in 3 different postures that influence lumbar spine angle: sitting, standing, and kneeling. They then performed a 15-minute dynamic stretching routine and repeated the standing contractions. Mean lumbar flexion angles of 0.5°, 9.9°, and 19.8° were adopted for standing, kneeling, and sitting, respectively. No statistically significant differences in the thoracic erector spinae EMD were found between the different postures. Lumbar erector spinae EMD was significantly longer in the sitting (94.1 ms) compared to the standing (69.9 ms) condition, with no differences compared to kneeling (79.7 ms). There were no statistically significant differences of the thoracic or lumbar erector spinae EMDs before and after dynamic stretching. These results suggest that dynamic stretching does not affect the mechanical behavior of the muscle-tendon-aponeurosis units in a way that alters force generation and transmission, but a sitting posture can alter how force is transmitted through the musculotendinous complex of the lumbar erector spinae.

Effects of trunk extensor muscle fatigue on repetitive lift (re)training using an augmented tactile feedback approach.

Augmented tactile and performance feedback has been used to (re)train a modified lifting technique to reduce lumbar spine flexion, which has been associated with low back disorder development during occupational repetitive lifting tasks. However, it remains unknown if the presence of trunk extensor neuromuscular fatigue influences learning of this modified lifting technique. Therefore, we compared the effectiveness of using augmented tactile and performance feedback to reduce lumbar spine flexion during a repetitive lifting task, in both unfatigued and fatigued states. Participants completed repetitive lifting tests immediately before and after training, and 1-week later, with half of the participants completing training after fatiguing their trunk extensor muscles. Both groups demonstrated learning of the modified lifting technique as demonstrated by increased thorax-pelvis coordination variability and reduced lumbar range of motion variability; however, experiencing trunk extensor neuromuscular fatigue during lift (re)training may have slight negative influences on learning the modified lifting technique. Practitioner summary: An augmented lift (re)training paradigm using tactile cueing and performance feedback regarding key movement features (i.e. lumbar spine flexion) can effectively (re)train a modified lifting technique to reduce lumbar flexion and redistribute motion to the hips and knees. However, performing (re)training while fatigued could slightly hinder learning this lifting technique.

The relationship between single muscle fibre and voluntary rate of force development in young and old males.

PURPOSE: It is suggested that the early phase (< 50 ms) of force development during a muscle contraction is associated with intrinsic contractile properties, while the late phase (> 50 ms) is associated with maximal force. There are no direct investigations of single muscle fibre rate of force development (RFD) as related to joint-level RFD METHODS: Sixteen healthy, young (n = 8; 26.4 ± 1.5 yrs) and old (n = 8; 70.1 ± 2.8 yrs) males performed maximal voluntary isometric contractions (MVC) and electrically evoked twitches of the knee extensors to assess RFD. Then, percutaneous muscle biopsies were taken from the vastus lateralis and chemically permeabilized, to assess single fibre function. RESULTS: At the joint level, older males were ~ 30% weaker and had ~ 43% and ~ 40% lower voluntary RFD values at 0-100 and 0-200 ms, respectively, than the younger ones (p ≤ 0.05). MVC torque was related to every voluntary RFD epoch in the young (p ≤ 0.001), but only the 0-200 ms epoch in the old (p ≤ 0.005). Twitch RFD was ~ 32% lower in the old compared to young (p < 0.05). There was a strong positive relationship between twitch RFD and voluntary RFD during the earliest time epochs in the young (≤ 100 ms; p ≤ 0.01). While single fibre RFD was unrelated to joint-level RFD in the young, older adults trended (p = 0.052-0.055) towards significant relationships between joint-level RTD and Type I single fibre RFD at the 0-30 ms (r2 = 0.48) and 0-50 ms (r2 = 0.49) time epochs. CONCLUSION: Electrically evoked twitches are good predictors of early voluntary RFD in young, but not older adults. Only the older adults showed a potential relationship between single fibre (Type I) and joint-level rate of force development.

Influence of Spine-Focused Verbal Instruction on Spine Flexion During Lifting.

Lifting with a flexed spine, especially near the end range of motion, has been identified as a potential risk factor for low back injury/pain. Therefore, individuals who develop discomfort from repetitive, prolonged and/or loaded flexed or slouched postures may benefit from a greater awareness of how to control and/or modify their spinal posture to avoid irritating their backs in these situations. This study was therefore designed to test the ability of spine-oriented verbal instructions to reduce intersegmental spine flexion during three lifting tasks. The lifts were first performed without any instructions on lifting technique. An audio recording was then played with instructions to limit bending in the lower back before repeating the lifts. Following the verbal instructions, maximum spine flexion angles significantly (p < 0.05) decreased at intersegmental levels in the lower thoracic and upper lumbar (T8/T9 to L2/L3) regions, but no significant changes were observed at the lower lumbar levels (L3/L4 to L5/S1). Thus, it is concluded that spine-oriented verbal instructions can decrease spine flexion during lifting; however, other cues/instructions may be required to target lower lumbar levels which have been identified as the most prone to injury/pain.

Comparing contractile properties within an integrated group of muscles: The abdominal wall.

The abdominal wall (external oblique (EO), internal oblique (IO), rectus abdominis (RA), and transverse abdominis (TrA)) is a functionally and anatomically integrated group of muscles. While the passive mechanical properties of the individual abdominal muscles have been studied previously, their contractile properties have yet to be described. Muscle samples were taken from the EO, IO, RA, and TrA of 6 Sprague-Dawley rats. Single muscle fibres were isolated from each sample, chemically permeabilized and tested in a Ca2+ (pCa 4.2) bath to determine their contractile properties: specific force, active modulus, unloaded shortening velocity, and rate of force redevelopment. Myosin heavy chain (MHC) isoforms were identified by gel electrophoresis to determine the fibre type of each tested fibre, as well as larger bundles of fibres. No type I fibres and only two type IIa fibres were tested, therefore type IIx and IIb fibres were combined for statistical analysis. There were no significant differences between muscles for specific force, active modulus, and unloaded shortening velocity (p > 0.05). Rate of force redevelopment was statistically significant (p = 0.029), with TrA being 62 % greater than EO, suggesting faster cross-bridge transitioning between low and high force-generating states in the TrA. The functional significance of this difference is unclear and will need to be studied further.

Synergistic control of hand position, velocity, and acceleration fluctuates across time during simulated Nordic skiing.

A central application of Uncontrolled Manifold (UCM) analysis is the quantification of the presence of motor synergies for the control of task-level variables during human movement. Choosing which task-level variable to analyse is a critical step in UCM analyses because this choice determines a relationship linking the motor performance and motor control. End-effector and/or centre of mass position are frequently chosen as task-level variables, whereas velocity and acceleration receive relatively little attention in this regard. Additionally, UCM analyses are most often conducted on discrete time points of a movement cycle, although these singular time points do not necessarily represent the characteristics of the whole cycle. Accordingly, the purpose of this investigation was to explore synergistic hand control during simulated Nordic skiing. It was hypothesized that 1) hand velocity would be a controlled task-level variable, 2) hand position would not be a controlled task-level variable, and 3) synergistic control of hand kinematics would be fluid (not constant throughout the movement cycle). Seven varsity-level skiers completed a simulated Nordic skiing task, producing specified power outputs on a Nordic skiing ergometer. Normalized time series of indices of task control from UCM analyses were analyzed using statistical parametric mapping. Synergies were observed for all of position, velocity, and acceleration (p < 0.0001), but not for the entire- skiing cycle. Therefore, UCM analyses conducted on discrete time points are not recommended without suitable a priori justification because its outputs fluctuate across time- especially during continuous movements. Velocity and acceleration should be considered in the choice of task-level variables, especially if they help define task performance.

Influence of weighted downhill running training on serial sarcomere number and work loop performance in the rat soleus.

Increased serial sarcomere number (SSN) has been observed in rats following downhill running training due to the emphasis on active lengthening contractions; however, little is known about the influence on dynamic contractile function. Therefore, we employed 4 weeks of weighted downhill running training in rats, then assessed soleus SSN and work loop performance. We hypothesised trained rats would produce greater net work output during work loops due to a greater SSN. Thirty-one Sprague-Dawley rats were assigned to a training or sedentary control group. Weight was added during downhill running via a custom-made vest, progressing from 5-15% body mass. Following sacrifice, the soleus was dissected, and a force-length relationship was constructed. Work loops (cyclic muscle length changes) were then performed about optimal muscle length (LO) at 1.5-3-Hz cycle frequencies and 1-7-mm length changes. Muscles were then fixed in formalin at LO. Fascicle lengths and sarcomere lengths were measured to calculate SSN. Intramuscular collagen content and crosslinking were quantified via a hydroxyproline content and pepsin-solubility assay. Trained rats had longer fascicle lengths (+13%), greater SSN (+8%), and a less steep passive force-length curve than controls (P<0.05). There were no differences in collagen parameters (P>0.05). Net work output was greater (+78-209%) in trained than control rats for the 1.5-Hz work loops at 1 and 3-mm length changes (P<0.05), however, net work output was more related to maximum specific force (R2=0.17-0.48, P<0.05) than SSN (R2=0.03-0.07, P=0.17-0.86). Therefore, contrary to our hypothesis, training-induced sarcomerogenesis likely contributed little to the improvements in work loop performance. This article has an associated First Person interview with the first author of the paper.

Dysfunctional paraspinal muscles in adult spinal deformity patients lead to increased spinal loading.

PURPOSE: Decreased spinal extensor muscle strength in adult spinal deformity (ASD) patients is well-known but poorly understood; thus, this study aimed to investigate the biomechanical and histopathological properties of paraspinal muscles from ASD patients and predict the effect of altered biomechanical properties on spine loading. METHODS: 68 muscle biopsies were collected from nine ASD patients at L4-L5 (bilateral multifidus and longissimus sampled). The biopsies were tested for muscle fiber and fiber bundle biomechanical properties and histopathology. The small sample size (due to COVID-19) precluded formal statistical analysis, but the properties were compared to literature data. Changes in spinal loading due to the measured properties were predicted by a lumbar spine musculoskeletal model. RESULTS: Single fiber passive elastic moduli were similar to literature values, but in contrast, the fiber bundle moduli exhibited a wide range beyond literature values, with 22% of 171 fiber bundles exhibiting very high elastic moduli, up to 20 times greater. Active contractile specific force was consistently less than literature, with notably 24% of samples exhibiting no contractile ability. Histological analysis of 28 biopsies revealed frequent fibro-fatty replacement with a range of muscle fiber abnormalities. Biomechanical modelling predicted that high muscle stiffness could increase the compressive loads in the spine by over 500%, particularly in flexed postures. DISCUSSION: The histopathological observations suggest diverse mechanisms of potential functional impairment. The large variations observed in muscle biomechanical properties can have a dramatic influence on spinal forces. These early findings highlight the potential key role of the paraspinal muscle in ASD.

Biomechanical Properties of Paraspinal Muscles Influence Spinal Loading-A Musculoskeletal Simulation Study.

Paraspinal muscles are vital to the functioning of the spine. Changes in muscle physiological cross-sectional area significantly affect spinal loading, but the importance of other muscle biomechanical properties remains unclear. This study explored the changes in spinal loading due to variation in five muscle biomechanical properties: passive stiffness, slack sarcomere length (SSL), in situ sarcomere length, specific tension, and pennation angle. An enhanced version of a musculoskeletal simulation model of the thoracolumbar spine with 210 muscle fascicles was used for this study and its predictions were validated for several tasks and multiple postures. Ranges of physiologically realistic values were selected for all five muscle parameters and their influence on L4-L5 intradiscal pressure (IDP) was investigated in standing and 36° flexion. We observed large changes in IDP due to changes in passive stiffness, SSL, in situ sarcomere length, and specific tension, often with interesting interplays between the parameters. For example, for upright standing, a change in stiffness value from one tenth to 10 times the baseline value increased the IDP only by 91% for the baseline model but by 945% when SSL was 0.4 µm shorter. Shorter SSL values and higher stiffnesses led to the largest increases in IDP. More changes were evident in flexion, as sarcomere lengths were longer in that posture and thus the passive curve is more influential. Our results highlight the importance of the muscle force-length curve and the parameters associated with it and motivate further experimental studies on in vivo measurement of those properties.

Investigating the active contractile function of the rat paraspinal muscles reveals unique cross-bridge kinetics in the multifidus.

PURPOSE: Various aspects of paraspinal muscle anatomy, biology, and histology have been studied; however, information on paraspinal muscle contractile function is almost nonexistent, thus hindering functional interpretation of these muscles in healthy individuals and those with low back disorders. The aim of this study was to measure and compare the contractile function and force-sarcomere length properties of muscle fibers from the multifidus (MULT) and erector spinae (ES) as well as a commonly studied lower limb muscle (Extensor digitorum longus (EDL)) in the rat. METHODS: Single muscle fibers (n = 77 total from 6 animals) were isolated from each of the muscles and tested to determine their active contractile function; all fibers used in the analyses were type IIB. RESULTS: There were no significant differences between muscles for specific force (sFo) (p = 0.11), active modulus (p = 0.63), average optimal sarcomere length (p = 0.27) or unloaded shortening velocity (Vo) (p = 0.69). However, there was a significant difference in the rate of force redevelopment (ktr) between muscles (p = < 0.0001), with MULT being significantly faster than both the EDL (p = < 0.0001) and ES (p = 0.0001) and no difference between the EDL and ES (p = 0.41). CONCLUSIONS: This finding suggests that multifidus has faster cross-bridge turnover kinetics when compared to other muscles (ES and EDL) when matched for fiber type. Whether the faster cross-bridge kinetics translate to a functionally significant difference in whole muscle performance needs to be studied further.

Influence of back muscle fatigue on dynamic lumbar spine stability and coordination variability of the thorax-pelvis during repetitive flexion-extension movements.

Previous work has identified that individuals adopt different dynamic lumbar spine stability responses when experiencing back muscle fatigue, and that the neuromuscular system adjusts multi-joint coordination in response to fatigue. Therefore, this study was designed to determine whether distinct differences in coordination and coordination variability would be observed for those who stabilize, destabilize, or demonstrate no change in dynamic stability when their back muscles are fatigued. Thirty participants completed two repetitive trunk flexion-extension trials (Rested, Fatigued) during which lumbar flexion-extension dynamic stability, thorax-pelvis movement coordination, and coupling angle variability (CAV) were assessed. Dynamic stability was evaluated using maximum Lyapunov exponents (λmax) with participants being allotted to stabilizer, destabilizer, or no change groups based on their stability response to fatigue. Each flexion-extension repetition was further segregated into two phases (flexion, extension) and vector coding analyses were implemented to determine thorax-pelvis coordination and CAV during each movement phase. Results demonstrated that when fatigued, ∼30% of individuals adopted more stable (lower λmax) flexion-extension movements and greater CAV during the extension phase, ∼17% of individuals became less stable (higher λmax) and exhibited decreased CAV during the extension phase, and the remaining âˆ¼53% of individuals expressed no change in dynamic stability or CAV. Additionally, more in-phase coordination patterns were generally observed across all individuals when fatigued. Altogether, this study highlights the heterogeneous nature of lumbar spine movement behaviours within a healthy population in response to fatigue.

Automated Segmentation of Spinal Muscles From Upright Open MRI Using a Multiscale Pyramid 2D Convolutional Neural Network.

STUDY DESIGN: Randomized trial. OBJECTIVE: To implement an algorithm enabling the automated segmentation of spinal muscles from open magnetic resonance images in healthy volunteers and patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Understanding spinal muscle anatomy is critical to diagnosing and treating spinal deformity.Muscle boundaries can be extrapolated from medical images using segmentation, which is usually done manually by clinical experts and remains complicated and time-consuming. METHODS: Three groups were examined: two healthy volunteer groups (N = 6 for each group) and one ASD group (N = 8 patients) were imaged at the lumbar and thoracic regions of the spine in an upright open magnetic resonance imaging scanner while maintaining different postures (various seated, standing, and supine). For each group and region, a selection of regions of interest (ROIs) was manually segmented. A multiscale pyramid two-dimensional convolutional neural network was implemented to automatically segment all defined ROIs. A five-fold crossvalidation method was applied and distinct models were trained for each resulting set and group and evaluated using Dice coefficients calculated between the model output and the manually segmented target. RESULTS: Good to excellent results were found across all ROIs for the ASD (Dice coefficient >0.76) and healthy (dice coefficient > 0.86) groups. CONCLUSION: This study represents a fundamental step toward the development of an automated spinal muscle properties extraction pipeline, which will ultimately allow clinicians to have easier access to patient-specific simulations, diagnosis, and treatment.

Dynamic Balance is Similar Between Lower Extremities in Elite Fencers.

BACKGROUND: Few studies have quantified dynamic balance in fencers despite previous suggestions that balance training may be beneficial for these athletes. Generally, asymmetry in dynamic balance performance between the left and right legs can be an indicator of lower extremity injury risk and used to monitor rehabilitation progress. Fencing is recognized as an asymmetric sport, therefore, differences in dynamic balance may exist among uninjured athletes. HYPOTHESIS/PURPOSE: The primary objective of this investigation was to evaluate whether asymmetry of dynamic balance is present in uninjured national-level fencers. It was hypothesized that elite uninjured fencers would demonstrate superior dynamic balance on the lead-leg of their fencing stance. A secondary objective was to compare dynamic balance performance of elite fencers to previously published data from high-level athletes participating in other sports. STUDY DESIGN: Descriptive Laboratory Study. METHODS: Fourteen uninjured elite competitive fencers were recruited. Subjects self-reported the lead leg of their fencing stance. Each participant performed the Y-Balance test (YBT), which represented a measurement of dynamic balance control, on both legs. Reach distances were recorded directly from a commercially available YBT apparatus. Four reach distances were recorded: anterior, posteromedial, posterolateral, and a composite measure was calculated. Distances were leg length-normalized and expressed as a percentage. Sample averages and standard deviations were derived for the four YBT measurements. RESULTS: There were no significant differences in reaching distance between the lead and trail legs in any of the four YBT measures (p ≥ 0.65). Fencers appeared to demonstrate larger normalized reach distances in the posterolateral and posteromedial directions than other athletes. CONCLUSIONS: The results of this study indicate that dynamic balance is not significantly different between the lead and trail legs in elite fencers, despite the asymmetrical nature of their sport. The apparent symmetry of dynamic balance control in uninjured fencers means that the YBT could be used in this population for monitoring progress during training and rehabilitation. LEVEL OF EVIDENCE: 2b.

Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders.

Low back pain disorders affect more than 80% of adults in their lifetime and are the leading cause of global disability. The muscles attaching to the spine (ie, paraspinal muscles) are critical for proper spine health and play a crucial role in the functioning of the spine and whole body; however, reports of muscle dysfunction and insufficiency in chronic LBP (CLBP) patients are common. This article presents a review of the current understanding of the relationship between paraspinal muscle pathophysiology and spine-related disorders. Human literature demonstrates a clear association between altered muscle structure/function, most notably fatty infiltration and fibrosis, and low back pain disorders; other associations, including muscle cell atrophy and fiber type changes, are less clear. Animal literature then provides some mechanistic insight into the complex relationships, including initiating factors and time courses, between the spine and spine muscles under pathological conditions. It is apparent that spine pathology can directly lead to changes in the paraspinal muscle structure, function, and biology. It also appears that changes to the muscle structure and function can directly lead to changes in the spine (eg, deformity); however, this relationship is less well studied. Future work must focus on providing insight into possible mechanisms that regulate spine and paraspinal muscle health, as well as probing how muscle degeneration/dysfunction might be an initiating factor in the progression of spine pathology.