Frequency-dependent changes in neuromuscular responses to cyclic lumbar flexion.

Repetitive lifting in the workplace has been identified to be a cause of low back disorders. Epidemiologic data further supports an hypothesis that higher repetition rate (i.e. frequency) is an added risk factor. The objective of this study was to provide experimental data testing the above hypothesis. An in vivo feline model was subjected to 20-min of cyclic lumbar loading at frequencies of 0.1 Hz and 0.5 Hz while monitoring the EMG from the L-3/4-L-5/6 multifidus muscles and the creep at the L-4/5 level. Seven hours of rest were allowed after the cyclic flexion/extension was terminated. During this rest period, a single test cycle was performed every hour to assess recovery of EMG and lumbar creep. The results demonstrate that cyclic lumbar flexion elicits a transient neuromuscular disorder consisting of EMG spasms during the cyclic loading and initial and delayed muscular hyperexcitabilities during the rest period. Cyclic loading at 0.5 Hz resulted in significant (p<0.05) increase in the hyperexcitability magnitude and duration during the recovery period. It was concluded that repetitive lumbar loading at fast rates is indeed a risk factor as it induces larger creep in the lumbar viscoelastic tissues which in turn intensify the resulting neuromuscular disorder.

Biomechanics and electromyography of a cumulative lumbar disorder: response to static flexion.

OBJECTIVE: To assess the mechanical and neurological processes active in the development of a cumulative trauma disorder (CTD) associated with repetitive exposure to periods of static lumbar flexion. METHODS: The spine of the feline model was subjected to a series of three 10 min sessions of static lumbar flexion with each session followed by a 10 min rest. A 7 h rest period was implemented after the series of three flexion-rest sessions while monitoring viscoelastic (disks, ligaments, etc.) creep and multifidus EMG. A model was fitted to the experimental data from the flexion-rest period and the 7 h recovery period. RESULTS: The creep developed in each 10 min static flexion period did not fully recovery during the following 10 min rest, resulting in a large cumulative creep at the end of the flexion-rest period. The cumulative creep did not fully recover over the following 7 h rest period. A neuromuscular disorder consisting of reduced muscular activity superimposed by spasms during static flexion periods and hyperexcitability during the 7 h recovery was evident. Comparison of the data to previous tests of continuous static flexion for 20 min reveal that the neuromuscular disorder elicited by the series of three 10 min flexion-rest was substantially attenuated when compared to a single 20 min static flexion although the overall work time was 50% larger. CONCLUSIONS: Frequent rest periods are highly beneficial in attenuating the development of a CTD, yet not able to prevent it, as viscoelastic tissues residual creep accumulates and its recovery is of extremely long duration. RELEVANCE: The data provides direct biomechanical and physiological evidence that explain the development of a CTD due to prolonged exposure to static lumbar flexion as well as confirms the epidemiological data correlating such work conditions with substantial increase in symptoms of low back disorders. The benefit of frequent rest periods in attenuating the risk of such a disorder is validated as an effective intervention.

Muscular dysfunction elicited by creep of lumbar viscoelastic tissue.

The biomechanics, histology and electromyography of the lumbar viscoelastic tissues and multifidus muscles of the in vivo feline were investigated during 20 min of static as well as cyclic flexion under load control and during 7 h of rest following the flexion. It was shown that the creep developed in the viscoelastic tissues during the 20 min of static or cyclic flexion did not fully recover over the 7 h of following rest. It was further seen that a neuromuscular disorder with five distinct components developed during and after the static and cyclic flexion. The neuromuscular disorder consisted of a decreasing magnitude of reflexive EMG from the multifidus upon flexion as well as of superimposed spasms. The recovery period was characterized by an initial muscle hyperexcitability, a slowly increasing reflexive EMG and a delayed hyperexcitability. Histological data from the supraspinous ligament demonstrate significant increase (x 10) in neutrophil density in the ligament 2 h into the recovery and even larger increase (x 100) 6 h into the recovery from the 20 min flexion, indicating an acute soft tissue inflammation. It was concluded that sustained static or cyclic loading of lumbar viscoelastic tissues may cause micro-damage in the collagen structure, which in turn reflexively elicit spasms in the multifidus as well as hyperexcitability early in the recovery when the majority of the creep recovers. The micro-damage, however, results in the time dependent development of inflammation. In all cases, the spasms, initial and delayed hyperexcitabilities represent increased muscular forces applied across the intervertebral joints in an attempt to limit the range of motion and unload the viscoelastic tissues in order to prevent further damage and to promote healing. It is suggested that a significant insight is gained as to the development and implications of a common idiopathic low back disorder as well as to the development of cumulative trauma disorders.

Neuromuscular disorders associated with static lumbar flexion: a feline model.

Static flexion of the lumbar spine with constant load applied to the viscoelastic structures for 20 minutes and for 50 minutes resulted in development of spasms and inhibition in the multifidus muscles (e.g., deep erector spinae) and in creep of the supraspinous ligament in the feline model. The development of spasms and inhibition was not dependent on load magnitude. It is suggested that occupational and sports activities which require prolonged static lumbar flexion within the physiological range can cause a "sprain"-like injury to the ligaments, which in turn reflexively induce spasms and inhibition in some erector spinae muscles. Such disorder may take a long time to recover, in the order of days to weeks, depending on the level of creep developed in the tissues.

Neuromuscular neutral zones associated with viscoelastic hysteresis during cyclic lumbar flexion.

STUDY DESIGN: The reflexive EMG from the L3-L4 to L5-L6 multifidus of the in vivo feline was recorded during application of single passive flexion-extension cycle of the lumbar spine. OBJECTIVE: To determine the effect of viscoelastic hysteresis associated with a single-cycle flexion-extension and of increasing cycle frequency on the initiation and cessation displacement and tension thresholds of reflexive EMG from the multifidus muscles. SUMMARY OF BACKGROUND DATA: It is known that reflexive EMG can be recorded from some paraspinal muscles as a result of mechanical stimulation of lumbar ligaments and other viscoelastic structures. It is also known that mechanical neutral zones exist in the spine, that viscoelastic hysteresis is associated with a stretch-release cycle, and that the rate of stretch and release has a profound impact on viscoelastic tissue responses. It is unknown what are the neurologic neutral zones of the spine within which reflexive EMG does not exist, as well as the dependence of such neurologic neutral zones on viscoelastic hysteresis and increasing frequency of a flexion-extension cycle. METHODS: Single passive flexion-extension cycles of frequencies ranging from 0.1 to 1.0 Hz were applied to the lumbar spine of the feline while recording intramuscular EMG from the L3-L4 to L5-L6 multifidus. The displacement and tension thresholds associated with the initiation and cessation of EMG activity during the cycle were analyzed with respect to the cycles' viscoelastic hysteresis and frequency. The peak EMG discharge was tested for relationships with cycle frequency. RESULTS: The displacement and tension thresholds during the flexion phase of the cycle were significantly lower than the corresponding thresholds in the extension phase of the cycle. As the cycle frequency increased, EMG was triggered significantly earlier (lower displacement and tension thresholds) in the flexion phase and terminated earlier (higher displacement and tension thresholds) in the extension phase. The peak EMG was significantly larger as cycle frequency increased. CONCLUSIONS: Reflexive muscle forces are triggered at lower displacement or tension during flexion but diminish early during extension, leaving the spine unprotected for a substantial part of the extension movement. The muscle forces are recruited earlier and with larger intensity as the velocity of the movement increases, lending more protection to the spine. Faster extension movement, however, creates a larger window during which the spine is exposed to instability and injury because of lack of muscle forces.

The effect of placing a tensioned graft across open growth plates. A gross and histologic analysis.

BACKGROUND: Midsubstance tears of the anterior cruciate ligament in skeletally immature patients are increasingly common and are a challenging problem. The results of nonoperative treatment are no better in children than they are in adults. Physeal-sparing reconstructive procedures have yielded poor results. Reconstructive procedures that are utilized in adults violate the physis, potentially resulting in growth abnormalities. The objective of this study was to provide a model for reconstruction of the anterior cruciate ligament in skeletally immature patients by evaluating the effects of a tensioned connective-tissue graft placed across the canine physis. METHODS: Twelve ten-week-old beagles underwent reconstruction of the anterior cruciate ligament consisting of placement of fascia lata autograft through drill-holes across the femoral and tibial physes, tensioning of the graft to 80 N, and fixing it with screws and washers. The contralateral limb served as a control. One dog was eliminated from the study secondary to a postoperative infection. Four months postoperatively, the dogs were killed and were inspected grossly, radiographically, and histologically for any evidence of growth disturbance. RESULTS: Significant valgus deformity of the distal part of the femur (p < 0.001) and significant varus deformity of the proximal part of the tibia (p = 0.03) developed in the treated limbs. Neither radiographic nor histologic examination demonstrated any evidence of physeal bar formation. CONCLUSIONS: Significant growth disturbances occur with excessively tensioned transphyseal reconstruction of the anterior cruciate ligament in the canine model. These growth disturbances occur without radiographic or histologic evidence of physeal bar formation.

Multifidus EMG and tension-relaxation recovery after prolonged static lumbar flexion.

STUDY DESIGN: The electromyogram (EMG) from the in vivo feline L1 to the L7 multifidus was recorded during the application of a 20-minute static lumbar flexion and after 7 hours of rest. OBJECTIVE: To determine the recovery of tension-relaxation and laxity in the lumbar viscoelastic structures as well as the recovery of reflexive EMG activity in the multifidus after prolonged static flexion. SUMMARY OF BACKGROUND: It has been established that prolonged static flexion of the spine induces creep or tension-relaxation in its viscoelastic structures as well as a sharp decrease in the reflexive activity of the dorsal musculature and initiation of spasms. Epidemiologic studies have pointed out that such static flexion is associated with unusually high rates of low back disorders. The rate and pattern of recovery of reflexive muscular activity with rest after static flexion is still unknown. METHODS: The lumbar spines of seven in vivo feline preparations were subjected to 20 minutes of passive anterior flexion followed by 7 hours of rest while monitoring flexion tension, EMG from the L1-L7 multifidus muscles, and the strain of the L4/L5 supraspinal ligament. A model describing the pattern of recovery of muscular activity and viscoelastic tension was developed. RESULTS: Twenty minutes of lumbar flexion was associated with an initial sharp decrease of multifidus EMG activity followed by spasms. During rest, EMG activity demonstrated an initial hyperexcitability on flexion, followed by an exponential recovery of muscle activity. Full recovery of residual strain in the L4/L5 supraspinous ligament and multifidus activity was not obtained after 7 hours of rest. CONCLUSIONS: Static flexion of the lumbar spine is an extremely imposing function on its viscoelastic tissues, resulting in spasms and requiring long periods of rest before normal functions are re-established.

Neuromuscular neutral zones sensitivity to lumbar displacement rate.

OBJECTIVES: To determine the displacement and tension thresholds (developed during anterior lumbar flexion) which trigger reflexive muscular activity in the multifidus muscles; their variability with the velocity of flexion; and the pattern of threshold variability across the lumbar spine.Design. An in-vivo study of the feline during passive lumbar flexion applied via the L-4/5 supraspinous ligament. METHOD: EMG from six pairs of intramuscular electrodes inserted in the L-1/2 to L-6/7 multifidus muscles was recorded while the lumbar spine was passively flexed to 75% of the physiological strain of the supraspinous ligament at rates of 17-100%/s. Three-dimensional models of tension threshold, flexion rate and lumbar levels were developed from the experimental data. RESULTS: Displacement and tension thresholds were the lowest at the fastest flexion rate and gradually increased as flexion rates decreased. Electromyographic activity was detected at low thresholds at the center of the flexion and at gradually increasing thresholds at higher and lower lumbar segments. CONCLUSION: Multifidus reflexive muscular activity, which stabilize the spine, is triggered at a displacement and tension thresholds of 5-15% of the physiological range. Earlier activation of muscular activity occurs as the velocity of flexion increases. Earlier activation also occurs near the center of flexion. RELEVANCE: Sensory-motor neurological feedback maintains spine stability and is responsive to the velocity of lumbar motion. A neuromuscular silence exists in small lumbar movements in which spine stability is not protected by the musculature. Spine models constructed to predict risk factors could benefit from incorporating this new information.

Multifidus spasms elicited by prolonged lumbar flexion.

STUDY DESIGN: The electromyogram of the L1-L7 multifidus muscles of the in vivo cat were recorded while applying a prolonged steady displacement to the lumbar spine through the L4-L5 supraspinous ligament, simulating a moderate anterior flexion. OBJECTIVE: To demonstrate that tension-relaxation and laxity of the viscoelastic structures (ligaments, discs, and capsules) induced by prolonged static flexion of the spine results in loss of reflexive muscular stabilizing activity and in muscular disorders that may lead to or are associated with low back pain. SUMMARY OF BACKGROUND: Epidemiologic data show that prolonged loading of the spine, such as in some occupational activities, can cause low back pain and muscle spasms. Direct experimental evidence linking prolonged loading to a decrease in spinal stability, low back pain, and muscle spasms was not found. It was hypothesized, however, that mechanoreceptors in the viscoelastic structures, when strained, reflexively activate the multifidus muscles to maintain intervertebral stability; that the reflexive muscular activity decreases with stress-relaxation and laxity in the viscoelastic structures; and that when severe strain and possible damage of the viscoelastic structures occurs with time, nociceptive receptors elicit spasms in the musculature and possible pain. METHODS: The lumbar spine of seven in vivo cat preparations was displaced through the L4-L5 supraspinous ligament into moderate flexion that was steadily maintained for 50 minutes while intramuscular electromyograms were recorded from each of the multifidus muscles of L1-L2 through L6-L7. Load and electromyogram were continuously monitored and recorded. Five additional preparations were used as controls, in which dissection and recordings were identical, but the lumbar flexion was excluded. RESULTS: Prolonged flexion of the lumbar spine resulted in initial reflexive electromyogram from the multifidus muscles that decreased to approximately 5% of its initial value as tension-relaxation began in the viscoelastic structures within the first 3 minutes, after which, random and unpredictable electromyogram discharges (i.e., spasms) of high amplitude were recorded from different levels. In some preparations the spasms were present in L1-L4, and in others in all the levels. In other preparations the spasms were recorded only at L5 and L6. The onset of the spasms was also unpredictable, because they were initiated in some cases within 2-3 minutes after the spine was loaded. In other cases, the spasms were observed anytime during the test period and up to 20 minutes after the load was removed. Spasms were also observed in the spinalis and longissimus muscles. CONCLUSIONS: Prolonged flexion of the lumbar spine results in tension-relaxation and laxity of its viscoelastic structures, loss of reflexive muscular activity within 3 minutes and electromyogram spasms in the multifidus and other posterior muscles.

Closed-loop control of muscle length through motor unit recruitment in load-moving conditions.

Neuroprostheses aimed at restoring lost movement in the limbs of spinal cord injured individuals are being developed in this laboratory. As part of this program, we have designed a digital proportional-integral-derivative controller integrated with a stimulation system which effects recruitment of motor units according to the size principle. This system is intended to control muscle length while shortening against fixed loads. Feline sciatic nerves were exposed and stimulated with ramp, triangular, sinusoidal, staircase and random signals as test inputs. Changes in muscle length and effective time delay under different conditions were measured and analyzed. Differences of tracking quality between open- and closed-loop conditions were examined through analysis of variance as well as the differences between small (250g) and large (1kg) loads. The results showed that parameters used to compare muscle length output to the input signals were dramatically improved in the closed-loop trials as compared to the open-loop condition. Mean squared correlation coefficients between input and output signals for ramp signals increased by 0.019, and for triangular signals by 0.12. Mean peak cross correlation between input and output signals for sinusoidal waveforms increased by 0.06, with decreases in time to peak cross correlation (effective time delay) from 195 to 38ms. In slow random signals (power up to 0.5Hz), peak cross correlation went from 0.74 to 0.89, and time-to-peak cross correlation decreased from 205 to 55ms. In fast random signals (power up to 1Hz), peak cross correlation went from 0.82 to 0.89, and time-to-peak cross correlation from 200 to 65ms. For staircase signals, both rise times and mean steady-state errors decreased. It was found that, once the length range was set, the load weight had no effect on tracking performance. Analysis of mean square error demonstrated that for all signals tested, the feedback decreased the tracking error significantly, whereas, again, load had no effect. The results suggest that tracking is vastly improved by using a closed-loop system to control muscle length, and that load does not affect the quality of signal tracking as measured by standard control system analysis methods.

Force and surface mechanomyogram frequency responses in cat gastrocnemius.

Muscle surface displacement is a mechanical event taking place simultaneously with the tension generation at the tendon. The two phenomena can be studied by the surface mechanomyogram signal (MMG) (produced by a laser distance sensor) and the force signal (from a load cell). The aim of this paper was to provide data on the reliability of the laser detected MMG in muscle mechanics research. To this purpose it was verified if the laser detected MMG was suitable to estimate a frequency response in the cat medial gastrocnemius and its frequency response was compared with the one retrieved by the force signal at the tendon level. The force and MMG from the exposed medial gastrocnemius of four cats were analysed. The frequency response was investigated by sinusoidally changing the number of orderly recruited motor units, in different trials, in the 0.4-6 Hz range. It resulted that it was possible to model the force and MMG frequency response by a critically damped second-order system with two real double poles and a pure time delay. On the average, the poles were at 1.83 Hz (with 22.6 ms delay) and at 2.75 Hz (with 38 ms delay) for force and MMG, respectively. It can be concluded that MMG appears to be a reliable tool to investigate the muscle frequency response during stimulated isometric contraction. Even though not statistically significant. the differences in the second-order system parameters suggest that different components of the muscle mechanical model may specifically affect the force or MMG.

Characterization of load-length-velocity relationships of nine different skeletal muscles.

A three-dimensional characterization of muscle load, length and velocity was obtained from nine muscles in the cat's hind limb through contractions where the muscles shortened against inertial-gravitational loads. A model based on the load-length characteristic and second-order dynamics describes shortening velocity related to load and length under these conditions. We conclude that this model describes well contraction velocity as function of length and load under inertial-gravitational load conditions, with correlation coefficients higher than 0.9 in most of the tested muscles.

Biexponential recovery model of lumbar viscoelastic laxity and reflexive muscular activity after prolonged cyclic loading.

OBJECTIVES: To determine the rest duration required for full recovery of reflexive muscular activity and laxity/creep induced in the lumbar viscoelastic structures (e.g., ligaments, discs, etc.) after 50 min of cyclic loading, and to develop a model describing such recovery. BACKGROUND: It is well established that steady, cyclic or vibratory loading of the lumbar spine induces laxity/creep in its viscoelastic structures. It was also shown that such viscoelastic creep does not fully recover when subjected to rest equal in duration to the loading period. Rest periods of 24 h, however, were more than sufficient to allow full recovery. The exact period of time allowing full recovery of viscoelastic laxity/creep, and its pattern is not known. It is also not known what is the duration required for full recovery of reflexive muscular activity lost due to the laxity/creep induced in the spine during cyclic loading. METHODS: The lumbar spine of 'in vivo' feline preparations was subjected to 50 min of 0.25 Hz cyclic loading applied v ia the L4/5 supraspinal ligament. At the end of the loading period the spine was subjected to prolonged rest, interrupted by a single cycle loading applied hourly for measurement purposes until the laxity was fully recovered (>90%). Reflexive EMG activity was recorded with wire electrodes from the L-1-L-7 multifidus muscles. A biexponential model was fitted to the load and EMG recorded in the recovery period in order to represent viscous and elastic components of structures with different architecture (e.g., disc vs. ligament). RESULTS: Full recovery of the laxity induced by 50 min of cyclic loading at 0.25 Hz required 7 h and was successfully fitted with a biexponential model. Similarly, EMG activity was fully recovered in 4 hours, and often exceeded its initial value during the following 3 h. CONCLUSIONS: Full recovery of laxity induced in the lumbar viscoelastic structures by a given period of cyclic loading requires rest periods, which are several folds longer than the loading duration. Similarly, reflexive muscular activity requires 4 h of rest in order to be restored. Meanwhile, significant laxity can be present in the joints, exposing the spine to potential injury and low back pain. Increased EMG activity at the end of the recovery period may indicate that pain was possibly induced in the spinal structures, inducing hyperexcitability of the muscles during passive loading. RELEVANCE: Although the data was derived from a feline model, and its extrapolation to the human model is not straightforward, the general pattern of decreasing reflexive muscular activity with cyclic loading is expected in both species. Therefore, workers who subject their spine to periods of cyclic loading may be exposed to prolonged periods of laxity beyond the neutral zone limits, without protection from the muscles and therefore the risk of possible injury and low back pain. Pain and muscle hyperexcitability could also be a factor associated with cyclic loading, being expressed several hours after work was completed.

Effect of intraarticular stainless steel implants on the health of the rabbit knee joint: an experimental study.

OBJECTIVE: This study was designed to investigate the histologic changes to the knee joints of rabbits after insertion of a metal implant in retrograde fashion. DESIGN: Eighteen rabbits had a modified stainless steel screw implanted in one knee, with the other knee serving as a sham-operated control. The animals were killed after two, six, or twelve months. OUTCOME MEASURES: The histologic status of the cartilage and synovium were graded by the Modified Mankin and Mirra criteria, respectively. RESULTS: At the time of killing, every insertion site was covered by fibrous tissue. Statistical analysis showed no significant differences in histologic scores between implanted and control knees. CONCLUSIONS: Insertion of a stable, well-fixed implant results in no deleterious effect to the knee joint.

Damage to rabbit femoral articular cartilage following direct impacts of uniform stresses: an in vitro study.

OBJECTIVE: To determine the acute gross and histologic damage resulting to femoral cartilage from an in vitro direct impact of uniform stress. DESIGN: Gross and histologic evaluations were performed on rabbit femoral condyles impacted by a drop-tower device. BACKGROUND: It is thought that impacts above a given threshold stress may initiate post-traumatic arthritis. The extent of damage following impacts of specific stress has not been previously studied. METHODS: 12 New Zealand White rabbit medial femoral condyles were divided into three groups by impact type and magnitude. A drop tower was used to strike the femoral condyle with a flat impactor, or with a custom contoured impactor. Gross and histological grades were given depending on the depth and number of fissures and cracks in the impacted condyle. RESULTS: The degree of damage correlated best with the type of impactor used and with the impact force; correlation between damage and impact stress was less significant. Contoured impactors tended to produce superficial fibrillation, while flat impactors tended to produce deep cracks. Impact forces above 500 N tended to create more severe damage than impact forces below 500 N. Subchondral bone remained intact in all cases and deep cartilage damage did not occur without disruption of more superficial layers. Poor correlation was found between damage as graded by gross examination versus damage graded histologically. CONCLUSIONS: Acute damage corresponds best with type of impactor and impact force, and not as well with impact stress. Micro structural injuries may be present in the absence of gross findings. RELEVANCE: Post-traumatic arthritis is a disabling disease thought to occur when a blow of stress above a given threshold is delivered to articular cartilage. Current animal models of post-traumatic arthritis are unable to characterize the impact stress applied to an articular surface. This study examines grossly and histologically the structural damage occurring as a result of impacts of given stress and force.

Force and surface mechanomyogram relationship in cat gastrocnemius.

The aim of this study was to compare the force (F) and the muscle transverse diameter changes during electrical stimulation of the motor nerve. In four cats the exposed motor nerves of the medial gastrocnemius were stimulated as follows: (a) eight separate trials at fixed firing rates (FR) from 5 to 50 Hz (9 s duration, supramaximal amplitude); (b) 5 to 50 Hz linear sweep in 2.5, 5, 7.5 and 10 s (supramaximal amplitude, separate trials); (c) four separate trials at 40 Hz, the motor units (MUs) being orderly recruited in 2.5, 5, 7.5 and 10 s. The muscle surface displacement was detected by a laser distance sensor pointed at the muscle surface. The resulting electrical signal was termed surface mechanomyogram (MMG). In stimulation patterns (a) and (b) the average F and MMG increased with FR. With respect to their values at 50 Hz the amplitude of the unfused signal oscillations at 5 Hz was much larger in MMG than in force. The signal rising phase was always earlier in MMG than in F. In (c) trials, F increased less in the first than in the second half of the recruiting time. MMG had an opposite behaviour. The results indicate that the force and the lateral displacement are not linearly related. The different behaviour of F and MMG, from low to high level of the MUs' pool activation, suggests that the force generation and the muscle dimensional change processes are influenced by different components of the muscle mechanical model.

Biomechanics of increased exposure to lumbar injury caused by cyclic loading: Part 1. Loss of reflexive muscular stabilization.

STUDY DESIGN: The recording of electromyographic responses from the in vivo lumbar multifidus of the cat, obtained while cyclic loading was applied as in occupational bending/lifting motion over time. OBJECTIVES: To determine whether the effectiveness of stabilizing reflexive muscular activity diminishes during prolonged cyclic activity; the recovery of lost muscle activity by a 10-minute rest; and whether such diminished muscular activity is caused by fatigue, neurologic habituation, or desensitization of mechanoreceptors in spinal viscoelastic tissues resulting from its laxity. SUMMARY OF BACKGROUND DATA: The literature repeatedly confirms observation that cyclic occupational functions expose workers to a 10-fold increase in episodes of low back injury and pain. The biomechanical evidence indicates that creep in the viscoelastic tissues of the spine causes increased laxity in the intervertebral joints. The impact of cyclic activity on the function of the muscles, which are the major stabilizing structures of the spine, is not known. METHODS: Electromyography was performed from the L1 to L7 in vivo multifidus muscles of the cat, while cyclic passive loading of 0.25 Hz was applied to L4-L5. Cyclic loading was applied for 50 minutes, followed by 10 minutes rest and a second 50-minute cyclic loading session. A third 50-minute cyclic loading period also was applied after the preload was reset to 0.5 N to offset the effect of laxity. RESULTS: Reflexive muscular activity was recorded from the multifidus muscles of all lumbar levels at the initiation of the first 50 minutes of cyclic loading. Activity recorded on electromyography quickly diminished with each cycle during the first 8 minutes of loading to 15% of its initial value. A slower decrease in muscular activity was evident throughout the remaining period, settling at 5% to 10% of its initial level by the end of 50 minutes. A 10-minute rest provided a 20% to 25% recovery of the electromyographic activity, but that was lost within the first minute of cycling. Offsetting the laxity in the spine resulted in full restoration of the electromyographic activity at all lumbar levels. CONCLUSIONS: The creep induced in the viscoelastic tissues of the spine as a result of cyclic loading desensitizes the mechanoreceptors within, which is manifest in dramatically diminished muscular activity, allowing full exposure to instability and injury, even before fatigue of the musculature sets in.

Biomechanics of increased exposure to lumbar injury caused by cyclic loading. Part 2. Recovery of reflexive muscular stability with rest.

STUDY DESIGN: Electromyographic responses from the lumbar multifidus muscle of the cat were recorded in vivo during 50 minutes of cyclic loading followed by 2 hours of rest. OBJECTIVE: To determine the rate of recovery of reflexive muscular stabilizing activity resulting from rest after viscoelastic laxity induced by 50 minutes of cyclic loading. SUMMARY OF BACKGROUND DATA: Muscular forces from agonists and antagonists were repeatedly shown to be the most significant stabilizing structures of the lumbar spine. Reflexive muscular coactivation force from the multifidus muscle elicited by mechanoreceptors in the spinal viscoelastic structures were, however, shown to diminish drastically with the onset of laxity in the viscoelastic structures. Data describing the rate of recovery of reflexive muscular coactivation forces resulting from rest after cyclic loading were not found. METHODS: Cyclic loading of the lumbar spine at 0.25 Hz was applied to L4-L5 for 50 minutes while electromyograms from the multifidus muscles of L1-L2 to L6-L7 were recorded. A rest period of up to 2 hours was given, during which electromyographic responses and load were measured every 10 minutes to sample recovery of laxity and reflexive muscular activity. RESULTS: Load and electromyographic response demonstrated an exponential decrease during the 50 minutes of cyclic loading. The first 10 minutes of rest allowed a significant recovery in laxity and muscle activity, with additional slow recovery over the next 20 to 30 minutes. The electromyographic response and load were increasing at an extremely slow rate thereafter. Overall, 2 hours of rest yielded only a 20% to 30% recovery in electromyographic response. Full recovery was never observed. A biexponential model was developed to predict loss and recovery of reflexive muscular activity and viscoelastic tension with laxity. CONCLUSIONS: Laxity in the viscoelastic structures of the lumbar spine desensitizes the mechanoreceptors within and causes loss of reflexive stabilizing forces from the multifidus muscles. The first 10 minutes of rest after cyclic loading results in fast partial recovery of muscular activity. However, full recovery is not possible even with rest periods twice as long as the loading period, placing the spine at an increased risk of instability, injury, and pain.

The ligamento-muscular stabilizing system of the spine.

STUDY DESIGN: Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles. OBJECTIVES: To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc. SUMMARY OF BACKGROUND DATA: The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found. METHODS: The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion. RESULTS: Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below. CONCLUSIONS: Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.

Methods to reduce the variability of EMG power spectrum estimates.

Three methods that can significantly reduce the variability of the EMG power density spectrum (PDS) variable by eliminating artifactual components are described. Two methods, one that allows the subtraction of power line noise in the time domain and one which allows the subtraction of system noise in the frequency domain from the EMG, were shown to be effective in helping to accurately estimate the median frequency (MF) of the PDS, and especially during low level contractions (0-25% maximal voluntary contraction, MVC) when the signal-to-noise ratio is unfavorable. The techniques eliminate the artifactual effects of system and power line noises from the EMG recordings throughout the force range (0-100% MVC) while preserving the native EMG power at all frequencies. It was also shown that if a technique to train subjects to produce their true MVC is employed, the absolute force/torque produced could be as much as 30% higher than in untrained MVC. The effect of true MVC production was also shown to be significant when interpretation of PDS variables are correlated to the processes which produce contraction.