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Study Design: A basic study of 56 porcine specimens in anterior shear loading., Objectives: To determine some modulators of the biomechanics of spinal motion segments exposed to acute shear loading and to identify the resultant injuries., Summary of Background Data: Most research on spinal injury mechanisms has focused on compressive loading, leaving a void in understanding of the effect of shear loading on origin of injury., Methods: Cervical spines (n = 56) of domestic pigs (6 months old) were loaded to failure in a specially designed jig that restricted their motion to primarily the shear plane. The specimens were tested at load rates of 100 N/sec or 10,810 N/sec and either in a flexed or neutral posture. In addition, the function of the individual structures of the motion segment were determined by serial dissection forming three groups: whole specimens, specimens with no posterior ligaments, and specimens with no posterior ligaments or facet joints. Load-deformation curves were collected using analog-to-digital sampling rates of 50 and 100 Hz. The mode of failure was then documented through systematic dissection of the specimen and/or radiology techniques. Modeling approaches were then used to gain insight into the failure mechanisms., Results: Dynamic loading (10,810 N/sec) and flexion of the specimens were found to increase the ultimate load at failure when compared with quasistatic loading (100 N/sec) and neutral postures. The disc resisted up to 70% of an applied load, with the pars interarticularis responsible for only 30% of the load. Nonetheless, the pars was the primary site of failure. Furthermore, higher load rates also caused endplate avulsion, specifically in the lateral borders of the anulus., Conclusions: The porcine model appears to reproduce injuries found in the data available on human lumbar material. Fractures in the pars interarticularis may not greatly weaken the joint, given the dominant role of the disc, but compromise its normal kinematics. Clinically, this may explain the occurrence of pars fractures, without total disability.

Study Design: A basic study of six human cervical spines, documenting displacement with applied forces mimicking palpation., Objectives: To assess the issues of motion palpation of joint restrictions and the inferred link to disease., Summary of Background Data: Although several investigators have suggested that the issue of asymmetry and normal-abnormal function should be assessed, data are unavailable., Methods: Atlas-axis specimens were harvested from six cadavers, cleaned of ligamentous and muscle tissue, and potted and secured with dental plaster. Forces (5-25 N) were applied along the mediolateral axis, and the corresponding displacement along three orthogonal axes were documented with infrared diodes and the Optotrak camera system (Northern Digital, Waterloo, Ontario, Canada). Specimen geometry and asymmetry were documented with plain radiographic film and a gimbal apparatus., Results: Each of the six specimens displayed different behavior and differing degrees of asymmetry (e.g., facet inclination 17-35 degrees) so that each was analyzed as a case study. Asymmetrical and discontinuous force-displacement correlations were linked to anatomic asymmetry that appeared to be of natural occurrence., Conclusions: Asymmetrical joint geometry is common and causes asymmetrical joint dynamics. Thus, a clinician attempting to palpate vertebral motion would be misled by assuming that perceived restricted joint motion universally represented a finding potentially amenable to manipulation. For spine palpation to be a valid indicator for manipulation, the clinician applying it must first be able to differentiate between asymmetrical motion caused by vertebral fixation and that caused by asymmetrical joint anatomy.

Study Design: An electromyogram procedure using spectral parameters to distinguish subjects with low back pain from those without., Objectives: To add to the growing database on this procedure, to assess the possible overfitting of data in the classification model, to determine whether a model based on a contraction level of 60% of maximum voluntary contraction can produce concordance rates similar to those in models based on 40% and 80% of maximum voluntary contraction, and to develop a classification model to distinguish subjects with low back pain from those without., Summary of Background Data: Other investigators have published a series of models in which spectral parameters measured during fatiguing contractions from the paraspinal muscles have been able to classify a subject into a low back pain or non-low back pain group with a more than 80% concordance rate., Methods: Subjects with chronic low back pain (N = 21) and without (N = 18) performed a series of isometric, fatiguing back extensor contractions in which the median power frequency was measured bilaterally from T9, L3, and L5. A Student's t test was used to determine which parameters would be entered into the classification models. Discriminant analysis and logistic regression procedures were used to develop models to classify subjects and were compared for overfitting of data based on the number of input parameters. The logistic regression method used a holdout group (N = 6) for validation., Results: The discriminant analysis selected all 10 input parameters and was believed to overfit the data. Logistic regression selected two parameters and had a concordance rate of 92.4%. Five of the six subjects in the holdout group were correctly classified., Conclusions: The use of spectral parameters to classify subjects with low back pain from those without appears to have merit. Compared with discriminant analysis, logistic regression provided an equally powerful method for classifying these two groups but did not overfit the data. Models based on 60% of maximum voluntary contraction demonstrated results comparable with those of previous research using 40% and 80% of maximum voluntary contraction.

Study Design: This study analyzed anatomic and neural control characteristics of the trunk musculature. Subjects were exposed to external shear and compressive loads with equivalent moments to evaluate activation patterns and loading on the low back., Objectives: The migration of activity between the thoracic and lumbar erector spinae muscle groups was examined to determine whether the motor control system chooses to minimize joint loading by recognizing differences in moment, compression, and shear support requirements and assigning muscle activation in the most appropriate way., Summary of Background Data: Loads were applied either parallel or perpendicular to the low back to create compressive or shear forces. No previous study has attempted to isolate the response of the trunk musculature with the type of external load., Methods: Eleven male subjects isometrically held an external load that was altered to create either a compressive or an anterior shear load on the low back but with equal extensor (reaction) moments (experiment 1). In a second experiment four men repeated the task with an increased range of applied loads (5-25 kg) together with measurements of intra-abdominal pressure., Results: The tasks with a compressive external load resulted in significantly higher levels of activation for all seven electromyographic channels recorded. Intraabdominal pressure, compressive and shear joint forces were all higher in the compression loading method when equal loads and low back moments were compared., Conclusions: It was concluded that the motor control system does not arrange muscle activation levels in a way to minimize lumbar spinal loading at least for the relatively low levels of this study. Biomechanical models that use the objective criterion of minimum joint load may not be representative of the motor control system, at least in the low back.

Study Design and Methods: This study used an anatomically detailed model of the lumbar tissues, driven from biologic signals of vertebral displacement and myoelectric signals, to estimate individual muscle and passive tissue force-time histories during the performance of the "flexion-relaxation" maneuver. Eight male university students performed three trials each of the "flexion-relaxation" maneuver with six pairs of surface myoelectric electrodes monitoring the right side of the trunk musculature, an electromagnetic device to record lumbar flexion, and videotape to record body segment displacement., Objectives: To examine the loads on individual tissues during the transfer of moment support responsibility from predominantly active muscle to predominantly passive tissue., Summary of Background Data: No previous studies, to the authors' knowledge, have examined individual tissue loading during the flexion-relaxation maneuver., Results: Although most subjects were able to "relax" their lumbar extensors in full flexion, activity remained in the thoracic extensors and abdominals. Tissue load predictions suggested that while the lumbar extensor muscles were neurally "relaxed" (i.e., myoelectric silence), substantial elastic forces would assist the passive tissues in extensor moment support. On average, subjects sustained almost 3 kN in compressive load on the lumbar spine and about 755 N of anterior shear during full flexion with only 8 kg held in the hands., Conclusions: The "relaxation" of lumbar extensor muscles appeared to occur only in an electrical sense because they generated substantial force elastically through stretching. Loading of the interspinous and supraspinous ligaments, in particular, was high relative to their failure tolerance.

This work investigated the passive bending properties of the intact human torso about its three principal axes of flexion: extension, lateral bending, and axial rotation. Additionally, the effects of wearing an abdominal belt and holding the breath (full inhalation) on trunk stiffness was investigated. The torsos of 22 males and 15 females were subjected to bending moments while "floating" in a frictionless jig with isolated torso bending measured with a magnetic device. Belts and breath holding appear to stiffen the torso about the lateral bending and axial rotation axes but not in flexion or extension. Torsos are stiffer in lateral bending and capable of storing greater elastic energy. Regression equations were formulated to define stiffness and energy stored for input to biomechanical models that examine low back function and for bioengineers designing hardware for stabilization and bracing or investigation of traumatic events such as automobile collision.

Force contributions from the facet complex and posterior ligaments during the generation of axial torque are a function of lordosis, and it has been speculated that these forces together with muscular contributions play a role in axial trunk twisting. This study investigated the electromyographic activity of the trunk musculature and torque-generating capacity of the lumbar spine under the conditions of normal lordosis, hyperlordosis, and hypolordosis. Eleven male subjects volunteered for this study. The subjects performed isometric twisting efforts and maximum dynamic twisting efforts at 30 degrees/sec. The myoelectric activity levels (normalized to maximal amplitude obtained from nontwist activities) were quite low despite maximal efforts to generate axial torque (for example: approximately 60% maximum voluntary contraction for latissimus dorsi and even lower for the abdominals). Furthermore, changes in lordosis did not produce any consistent changes in muscle activity, although a hyperlordotic spine produced significantly smaller axial torques, and a hypolordotic spine smaller still. Larger torques were measured during all three conditions of lordosis, as the subjects rotated toward an untwisted position, and lower torques as the subjects rotated away. The opposite trend was observed, however, in myoelectric activity of the agonistic side of latissimus dorsi, the thoracic level of erector spine, and the lumbar level of erector spinae, i.e., larger amplitudes were observed as the trunk was twisted away from the untwisted position. These data suggest that tissues other than muscle (i.e., passive tissue) contribute significantly to axial torque production and that the flexed and twisted spine is less able to resist applied axial torques, possibly increasing the risk of torsional injury.

Many studies have examined the mechanics of the lumbar spine in various planes, but only a limited number of three-dimensional investigations have been reported. Analysis of the low back during complex, dynamic postures demands rigorous representation of the trunk musculature. The data of this study demonstrated the force and torque contributions of approximately 50 laminas of various trunk muscles to flexion-extension, lateral bending, and axial twisting torque at the L4-L5 joint. This analysis was conducted with the spine in an upright standing posture and when fully flexed (60 degrees), laterally bent (25 degrees), and axially twisted (10 degrees) together with two examples of combined postures. Maximum moment potential, muscle length excursions, and the resultant compressive, anteroposterior shear, and lateral shear forces on the joint were also computed. The results indicate that the position of the vertebrae and their orthopaedic axes, which are a function of spinal posture, are an important factor in the reasonable determination of joint compressive, lateral shear, and anteroposterior shear loads. Muscle length changes that exceeded 20% of their respective length during upright standing were not observed during a full axial twist, but were observed in portions of the abdominal obliques during lateral bending, and in some extensors during full flexion. Extreme postures tended to change the torque potential of some muscles and influence joint load. Various portions of erector spinae were observed to have appreciable potential to generate torque about all three orthopaedic axes. This observation supports the notion held by some therapists that conditioning of the erector spinae is of utmost importance.

An anatomic-mathematical representation of the individual ligaments and disc at L4-L5 was used in a model to examine their role in joint behavior. Geometry of the anatomic components was obtained from cadaveric dissection and the anatomic literature; mechanical properties were obtained from various literature sources. Resistance to flexion of the L4-L5 joint was simulated using various ligament cross-sectional areas, and combined loading modes of compression coupled with bending in an attempt to understand physiologic conditions that may occur during activities such as lifting. Results suggest that the interspinous ligament sustains the greatest stress during flexion at L4-L5, is the dominant component in resistance to flexion, and also creates large shear components that must be resisted by the facet complex. Simulated compressive loads of 6300 N were noted to allow an additional 2 degrees of flexion at the joint.

This work describes a dynamic model of the low back that incorporates extensive anatomical detail of a three-dimensional musculo-ligamentous-skeletal system. The reactive moment about L4-L5, determined from sagittal plane lifts, was partitioned into restorative components provided by the disc in bending, ligament strain, and active muscle contraction. Skeletal kinematics were obtained from cine analysis of markers on the rib cage and pelvis. The musculature was driven from surface EMG collected from six sites. When compared with past models, features of this model included improved anatomical modeling, improved monitoring of vertebral motion unit kinematics, improved estimation of neural activation of the musculature, and consideration of the effects of muscle length, velocity, cross-sectional area and passive elasticity in force estimation. Estimations of L4-L5 disc compression and shear were, on average, 16.2% and 42.5% lower, respectively, than those calculated from a simple 5 cm erector tissue moment arm length. There was no need to invoke intra-abdominal pressure or other contentious compression-reducing mechanisms. Muscle activity, particularly that of the sacrospinalis, dominated the generation of the restorative moment. Ligaments played a very minor role in the lifts studied. High muscle loads are consistent with the common clinical observation of muscle strain often produced by load handling.