Ankle bracing and the neuromuscular factors influencing joint stiffness.

CONTEXT: Health care professionals commonly prescribe external stabilization to decrease the incidence and severity of ankle sprains. The mechanism for this decrease is not clearly understood. Examining the effects of ankle bracing on biomechanical stability and influencing factors may provide important information regarding the neuromuscular effects of bracing. OBJECTIVE: To study the effects of 2 different ankle braces on the neuromuscular factors influencing ankle stiffness. DESIGN: Mixed-model repeated-measures design. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-eight physically active participants composing 2 groups: 14 with unilateral functional ankle instability (age = 26.19 +/- 6.46 years, height = 166.07 +/- 12.90 cm, mass = 69.90 +/- 13.46 kg) and 14 with bilaterally stable ankles (age = 23.76 +/- 5.82 years, height = 174.00 +/- 11.67 cm, mass = 68.60 +/- 13.12 kg). INTERVENTION(S): Participants were fitted with surface electromyography electrodes over the peroneus longus, peroneus brevis, tibialis anterior, and soleus muscles. Each participant received transient motion oscillations to his or her ankle on a custom-built medial-lateral swaying cradle in each of 3 conditions: no ankle brace (NB), lace-up brace (LU), and semirigid brace (SR). MAIN OUTCOME MEASURE(S): Ankle stiffness as measured by the cradle and preactivation levels (percentage of maximal voluntary isometric contraction) of the 4 test muscles. RESULTS: Stiffness levels increased across brace conditions (NB = 24.79 +/- 6.59 Nm/rad, LU = 28.29 +/- 7.05 Nm/rad, SR = 33.22 +/- 8.78 Nm/rad; F(2,52) = 66.185, P < .001). No differences were found between groups for rotational stiffness (stable = 27.36 +/- 6.17 Nm/rad, unstable = 30.18 +/- 8.21 Nm/rad; F(1,26) = 1.084, P = .307). Preactivation levels did not change for any of the tested muscles with the application of an ankle brace (F(2,52) = 1.326, P = .275). CONCLUSIONS: The increase in ankle rotational stiffness with the addition of an ankle brace and the lack of any demonstrable neuromuscular changes suggested ankle braces passively contributed to the stability of the system.

Linear time delay methods and stability analyses of the human spine. Effects of neuromuscular reflex response.

Linear stability methods were applied to a biomechanical model of the human musculoskeletal spine to investigate effects of reflex gain and reflex delay on stability. Equations of motion represented a dynamic 18 degrees-of-freedom rigid-body model with time-delayed reflexes. Optimal muscle activation levels were identified by minimizing metabolic power with the constraints of equilibrium and stability with zero reflex time delay. Muscle activation levels and associated muscle forces were used to find the delay margin, i.e., the maximum reflex delay for which the system was stable. Results demonstrated that stiffness due to antagonistic co-contraction necessary for stability declined with increased proportional reflex gain. Reflex delay limited the maximum acceptable proportional reflex gain, i.e., long reflex delay required smaller maximum reflex gain to avoid instability. As differential reflex gain increased, there was a small increase in acceptable reflex delay. However, differential reflex gain with values near intrinsic damping caused the delay margin to approach zero. Forward-dynamic simulations of the fully nonlinear time-delayed system verified the linear results. The linear methods accurately found the delay margin below which the nonlinear system was asymptotically stable. These methods may aid future investigations in the role of reflexes in musculoskeletal stability.

The viscoelastic standard nonlinear solid model: predicting the response of the lumbar intervertebral disk to low-frequency vibrations.

Due to the mathematical complexity of current musculoskeletal spine models, there is a need for computationally efficient models of the intervertebral disk (IVD). The aim of this study is to develop a mathematical model that will adequately describe the motion of the IVD under axial cyclic loading as well as maintain computational efficiency for use in future musculoskeletal spine models. Several studies have successfully modeled the creep characteristics of the IVD using the three-parameter viscoelastic standard linear solid (SLS) model. However, when the SLS model is subjected to cyclic loading, it underestimates the load relaxation, the cyclic modulus, and the hysteresis of the human lumbar IVD. A viscoelastic standard nonlinear solid (SNS) model was used to predict the response of the human lumbar IVD subjected to low-frequency vibration. Nonlinear behavior of the SNS model was simulated by a strain-dependent elastic modulus on the SLS model. Parameters of the SNS model were estimated from experimental load deformation and stress-relaxation curves obtained from the literature. The SNS model was able to predict the cyclic modulus of the IVD at frequencies of 0.01 Hz, 0.1 Hz, and 1 Hz. Furthermore, the SNS model was able to quantitatively predict the load relaxation at a frequency of 0.01 Hz. However, model performance was unsatisfactory when predicting load relaxation and hysteresis at higher frequencies (0.1 Hz and 1 Hz). The SLS model of the lumbar IVD may require strain-dependent elastic and viscous behavior to represent the dynamic response to compressive strain.

Effects of trunk exertion force and direction on postural control of the trunk during unstable sitting.

BACKGROUND: Pushing and pulling exertions have been implicated as risk factors of low-back disorders. In an attempt to investigate the mechanisms by which pushing and pulling influence risk for low-back disorders, the goal of this study was to investigate the effects of trunk exertion force and exertion direction on postural control of the trunk during unstable sitting. METHODS: Seat movements were recorded while subjects maintained a seated posture on a wobbly chair against different exertion forces (0N, 40N, and 80N) and exertion directions (trunk flexion and extension). Postural control of the trunk was assessed from kinematic variability (root-mean-squared amplitude and 95% ellipse area) and non-linear stability analyses (stability diffusion exponent and maximum finite-time Lyapunov exponent). FINDINGS: Kinematic variability and non-linear stability estimates increased as exertion force increased including root-mean-squared amplitude (P<0.001), 95% ellipse area (P<0.001), stability diffusion exponent (P=0.042), and maximum finite-time Lyapunov exponent (P<0.001). A subset of measures indicated postural control of the trunk was poorer during flexion exertions compared to extension exertions including root-mean-squared amplitude (P<0.001), 95% ellipse area (P=0.046), and maximum finite-time Lyapunov exponent (P=0.002). INTERPRETATION: Trunk exertion force and exertion direction affect postural control of the trunk. This study may aid in understanding how pushing and pulling exertions can potentially contribute to low-back disorders.

Process stationarity and reliability of trunk postural stability.

BACKGROUND: Empirical assessments of torso stability can be estimated from postural variability and nonlinear analyses of seated balance tasks. However, processing methods require sufficient signal duration and test-retest experiments require the assessment must be reliable. Our goal was to characterize the reliability and establish the trial duration for torso stability assessment. METHODS: Kinetic and kinematic data were recorded while subjects maintained a seated posture on a wobbly seat pan. Stability was evaluated from dynamic variability and nonlinear stability analyses. Process stationarity of the measured signals characterized the minimum necessary trial duration. Intra-class correlations measured within-session and between-session reliability. FINDINGS: Trial duration necessary to achieve process stationarity was 30.2 s. Shorter time to stationarity was observed with measures that included multi-dimensional movement behavior. Summary statistics of movement variability demonstrated moderate intra-session reliability, intra-class correlation=0.64 (range 0.38-0.87). Inter-session reliability for movement variance was moderate, intra-class correlation=0.42 (range 0.22-0.64). Nonlinear stability measures typically performed better than estimates of variability with inter-session reliability as high as intra-class correlation=0.83. Process stationarity and reliability were improved in more difficult balance conditions. INTERPRETATION: To adequately capture torso dynamics during the stability assessment the trial duration should be at least 30 s. Moderate to excellent test-retest reliability can be achieved in intra-session analyses, but more repeated measurements are required for inter-session comparisons. Stability diffusion exponents, H(S), and the Lyapunov exponents provide excellent measures for intra-session analyses, while H(S) provides excellent inter-session comparisons of torso stability.

Effects of seated whole-body vibration on postural control of the trunk during unstable seated balance.

BACKGROUND: Low back disorders and their prevention is of great importance for companies and their employees. Whole-body vibration is thought to be a risk factor for low back disorders, but the neuromuscular, biomechanical, and/or physiological mechanisms responsible for this increased risk are unclear. The purpose of this study was to measure the acute effect of seated whole-body vibration on the postural control of the trunk during unstable seated balance. METHODS: Twenty-one healthy subjects (age: 23 years (SD 4 years)) were tested on a wobble chair designed to measure trunk postural control. Measurements of kinematic variance and non-linear stability control were based on seat angle before and after 30 min of seated whole-body vibration (bandwidth=2-20 Hz, root-mean-squared amplitude=1.15m/s(2)). FINDINGS: All measures of kinematic variance of unstable seated balance increased (P<0.05) after vibration including: ellipse area (35.5%), root-mean-squared radial lean angle (17.9%), and path length (12.2%). Measures of non-linear stability control also increased (P<0.05) including Lyapunov exponent (8.78%), stability diffusion analysis (1.95%), and Hurst rescaled range analysis (5.2%). INTERPRETATION: Whole-body vibration impaired postural control of the trunk as evidenced by the increase in kinematic variance and non-linear stability control measures during unstable sitting. These findings imply an impairment in spinal stability and a mechanism by which vibration may increase low back injury risk. Future work should investigate the effects of whole-body vibration on the anatomical and neuromuscular components that contribute to spinal stability.

Dynamic stability differences in fall-prone and healthy adults.

Typical stability assessments characterize performance in standing balance despite the fact that most falls occur during dynamic activities such as walking. The objective of this study was to identify dynamic stability differences between fall-prone elderly individuals, healthy age-matched adults, and young adults. Three-dimensional video-motion analysis kinematic data were recorded for 35 contiguous steps while subjects walked on a treadmill at three speeds. From this data, we estimated the vector from the center-of-mass to the center of pressure at each foot-strike. Dynamic stability of walking was computed by methods of Poincare analyses of these vectors. Results revealed that the fall-prone group demonstrated poorer dynamic stability than the healthy elderly and young adult groups. Stability was not influenced by walking velocity, indicating that group differences in walking speed could not fully explain the differences in stability. This pilot study supports the need for future investigations using larger population samples to study fall-prone individuals using nonlinear dynamic analyses of movement kinematics.

Active trunk stiffness during voluntary isometric flexion and extension exertions.

OBJECTIVE: Compare muscle activity and trunk stiffness during isometric trunk flexion and extension exertions. BACKGROUND: Elastic stiffness of the torso musculature is considered the primary stabilizing mechanism of the spine. Therefore, stiffness of the trunk during voluntary exertions provides insight into the stabilizing control of pushing and pulling tasks. METHODS: Twelve participants maintained an upright posture against external flexion and extension loads applied to the trunk. Trunk stiffness, damping, and mass were determined from the dynamic relation between pseudorandom force disturbances and subsequent small-amplitude trunk movements recorded during the voluntary exertions. Muscle activity was recorded from rectus abdominus, external oblique, lumbar paraspinal, and internal oblique muscle groups. RESULTS: Normalized electromyographic activity indicated greater antagonistic muscle recruitment during flexion exertions than during extension. Trunk stiffness was significantly greater during flexion exertions than during extension exertions despite similar levels of applied force. Trunk stiffness increased with exertion effort. CONCLUSION: Theoretical and empirical analyses reveal that greater antagonistic cocontraction is required to maintain spinal stability during trunk flexion exertions than during extension exertions. Measured differences in active trunk stiffness were attributed to antagonistic activity during flexion exertions with possible contributions from spinal kinematics and muscle lines of action. APPLICATION: When compared with trunk extension exertions, trunk flexion exertions such as pushing tasks require unique neuromuscular control that is not simply explained by differences in exertion direction. Biomechanical analyses of flexion tasks must consider the stabilizing muscle recruitment patterns when evaluating spinal compression and shear loads.

Effect of augmented plantarflexion power on preferred walking speed and economy in young and older adults.

With age, loss of skeletal muscle mass (sarcopenia) results in decreased muscle strength and power. Decreased strength and power, in turn, are closely linked with declines in physical function. Preferred walking speed, a marker of physical function, is slower in older adults compared to young adults. Research suggests that older adults may walk slower as a consequence of decreased plantarflexor power at push-off. In this study, we hypothesized that providing additional plantarflexion (PF) power during push-off would (1) increase preferred walking speed, and (2) reduce metabolic cost of transport (MCOT), in young and older adults. PF power was augmented using powered ankle-foot orthoses (PAFOs). The PAFOs, which use pneumatic actuators to provide an additional PF moment, were based on a design by Ferris et al. [Ferris DP, Czerniecki JM, Hannaford B. An ankle-foot orthosis powered by artificial pneumatic muscles. J Appl Biomech 2005;21:189-97.]. Nine young (23.3+/-1.6 years) and seven older (74.6+/-6.6 years) adults participated. For the young adults, eight out of nine increased their preferred walking speed when push-off power was augmented (1.18+/-0.16 to 1.25+/-0.16m/s, p=0.03). A similar, but non-significant, trend in preferred walking speed was observed for the older adults. With augmented push-off power, MCOT for young adults decreased from 0.395+/-0.057 to 0.343+/-0.047 (p=0.008); indicating that the neuromuscular system was able to adapt to use external energy to reduce metabolic cost. Only three older adults were tested but MCOT values showed a similar trend. Augmenting PF power increases gait speed and reduces MCOT in young adults. Older adults may need a longer period to take advantage of additional push-off power.

The influence of gait speed on local dynamic stability of walking.

The focus of this study was to examine the role of walking velocity in stability during normal gait. Local dynamic stability was quantified through the use of maximum finite-time Lyapunov exponents, lambda(Max). These quantify the rate of attenuation of kinematic variability of joint angle data recorded as subjects walked on a motorized treadmill at 20%, 40%, 60%, and 80% of the Froude velocity. A monotonic trend between lambda(Max) and walking velocity was observed with smaller lambda(Max) at slower walking velocities. Smaller lambda(Max) indicates more stable walking dynamics. This trend was evident whether stride duration variability remained or was removed by time normalizing the data. This suggests that slower walking velocities lead to increases in stability. These results may reveal more detailed information on the behavior of the neuro-controller than variability-based analyses alone.

Role of reflex dynamics in spinal stability: intrinsic muscle stiffness alone is insufficient for stability.

Spinal stability is related to both the intrinsic stiffness of active muscle as well as neuromuscular reflex response. However, existing analyses of spinal stability ignore the role of the reflex response, focusing solely on the intrinsic muscle stiffness associated with voluntary activation patterns in the torso musculature. The goal of this study was to empirically characterize the role of reflex components of spinal stability during voluntary trunk extension exertions. Pseudorandom position perturbations of the torso and associated driving forces were recorded in 11 healthy adults. Nonlinear systems-identification analyses of the measured data provided an estimate of total systems dynamics that explained 81% of the movement variability. Proportional intrinsic response was less than zero in more than 60% of the trials, e.g. mean value of P(INT) during the 20% maximum voluntary exertion trunk extension exertions -415+/-354N/m. The negative value indicated that the intrinsic muscle stiffness was not sufficient to stabilize the spine without reflex response. Reflexes accounted for 42% of the total stabilizing trunk stiffness. Both intrinsic and reflex components of stiffness increased significantly with trunk extension effort. Results reveal that reflex dynamics are a necessary component in the stabilizing control of spinal stability.

Validity and reliability of a new in vivo ankle stiffness measurement device.

This investigation was designed to test the validity and reliability of a new measure of inversion/eversion ankle stiffness on a unique medial/lateral swaying cradle device utilizing a test/retest with comparison to a known standard. Ankle stiffness is essential to maintaining joint stability. Most ankle injuries occur via an inversion mechanism. To date, very little information is available regarding stiffness of the evertor muscles in the prevention of excessive inversion joint rotation. Transient oscillation data representing inversion/eversion stiffness was obtained in a bipedal weight-bearing stance with an upright posture. Using commercially available springs with stiffness of 4.80N/cm the measured value recorded by the cradle was 4.87N/cm. Mean active stiffness values of the ankle were 35.70Nm/cm (SD 9.45). The trial-to-trial reliability ICC (2,1) coefficient was 0.96 with an SEM of 2.05Nm/rad, and the day-to-day reliability ICC (2,k) coefficient was 0.93 and an SEM of 3.00Nm/rad. The results demonstrate that inversion/eversion ankle stiffness measures on this device are a valid, repeatable and consistent measure. This is relevant because the ability to accurately quantify inversion/eversion ankle stiffness will improve our understanding of biomechanical stability and factors that influence it. It will also enable identification of ankle injury risk factors that will lead to more efficient rehabilitation programs and injury prevention strategies.

Role of reflex gain and reflex delay in spinal stability--a dynamic simulation.

The goal of this study was to investigate the role of reflex and reflex time delay in muscle recruitment and spinal stability. A dynamic biomechanical model of the musculoskeletal spine with reflex response was implemented to investigate the relationship between reflex gain, co-contraction, and stability in the spine. The first aim of the study was to investigate how reflex gain affected co-contraction predicted in the model. It was found that reflexes allowed the model to stabilize with less antagonistic co-contraction and hence lower metabolic power than when limited to intrinsic stiffness alone. In fact, without reflexes there was no feasible recruitment pattern that could maintain spinal stability when the torso was loaded with 200N external load. Reflex delay is manifest in the paraspinal muscles and represents the time from a perturbation to the onset of reflex activation. The second aim of the study was to investigate the relationship between reflex delay and the maximum tolerable reflex gain. The maximum acceptable upper bound on reflex gain decreased logarithmically with reflex delay. Thus, increased reflex delay and reduced reflex gain requires greater antagonistic co-contraction to maintain spinal stability. Results of this study may help understanding of how patients with retarded reflex delay utilize reflex for stability, and may explain why some patients preferentially recruit more intrinsic stiffness than healthy subjects.

Fatigue, vertical leg stiffness, and stiffness control strategies in males and females.

CONTEXT: Fatigue appears to influence musculoskeletal injury rates during athletic activities, but whether males and females respond differently to fatigue is unknown. OBJECTIVE: To determine the influence of fatigue on vertical leg stiffness (K (VERT)) and muscle activation and joint movement strategies and whether healthy males and females respond similarly to fatigue. DESIGN: Repeated-measures design with all data collected during a single laboratory session. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Physically active males (n = 11) and females (n = 10). INTERVENTION(S): Subjects performed hopping protocols at 2 frequencies before and after fatigue, which was induced by repeated squatting at submaximal loads. MAIN OUTCOME MEASURE(S): We measured K (VERT) with a forceplate and peak muscle activity of the quadriceps, hamstrings, gastrocnemius, soleus, and anterior tibialis muscles with surface electromyography. Sagittal-plane kinematics at the knee and ankle were recorded with an electrogoniometer. RESULTS: After fatigue, K (VERT) was unchanged for all subjects. However, both males and females demonstrated reduced peak hamstrings ( P = .002) and anterior tibialis ( P = .001) activation, coupled with increased gastrocnemius ( P = .005) and soleus ( P = .001) peak activity, as well as increased quadriceps-hamstrings ( P = .005) and gastrocnemius/soleus-anterior tibialis coactivation ratios ( P = .03) after fatigue. Overall, females demonstrated greater quadriceps-hamstrings coactivation ratios than males, regardless of the fatigue condition ( P = .026). Only females showed increased knee flexion at initial contact after fatigue during hopping ( P = .03). CONCLUSIONS: Although K (VERT) was unaffected, the peak muscle activation and joint movement strategies used to modulate K (VERT) were affected after fatigue. Once fatigued, both males and females used an ankle-dominant strategy, with greater reliance on the ankle musculature and less on the knee musculature. Also, once fatigued, all subjects used an antagonist inhibition strategy by minimizing antagonist coactivation. Overall, females used a more quadriceps-dominant strategy than males, showing greater quadriceps activity and a larger quadriceps-hamstrings coactivation ratio. Changes in muscle activation and coactivation ratios because of fatigue and sex are suggested to alter knee joint stability and increase anterior cruciate ligament injury risk.

Passive mechanical properties of maturing extensor digitorum longus are not affected by lack of dystrophin.

Mechanical weakness of skeletal muscle is thought to contribute to onset and early progression of Duchenne muscular dystrophy, but this has not been systematically assessed. The purpose of this study was to determine in mice: (1) whether the passive mechanical properties of maturing dystrophic (mdx) muscles were different from control; and (2) if different, the time during maturation when these properties change. Prior to and following the overt onset of the dystrophic process (14-35 days), control and dystrophic extensor digitorum longus (EDL) muscles were subjected to two passive stretch protocols in vitro (5% strain at instantaneous and 1.5 L(0)/s strain rates). Force profiles were fit to a viscoelastic muscle model to determine stiffness and damping. The mdx and control EDL muscles exhibited similar passive mechanical properties at each age, suggesting a functional threshold for dystrophic muscle below which damage may be minimized. Determining this threshold may have important clinical implications for treatments of muscular dystrophy involving physical activity.

Stability of dynamic trunk movement.

STUDY DESIGN: Nonlinear systems analyses of trunk kinematics were performed to estimate control of dynamic stability during repetitive flexion and extension movements. OBJECTIVE: Determine whether movement pace and movement direction of dynamic trunk flexion and extension influence control of local dynamic stability. SUMMARY OF BACKGROUND DATA: Spinal stability has been previously characterized in static, but not in dynamic movements. Biomechanical models make inferences about static spinal stability, but existing analyses provide limited insight into stability of dynamic movement. Stability during dynamic movements can be estimated from Lyapunov analyses of empirical data. METHODS: There were 20 healthy subjects who performed repetitive trunk flexion and extension movements at 20 and 40 cycles per minute. Maximum Lyapunov exponents describing the expansion of the kinematic state-space were calculated from the measured trunk kinematics to estimate stability of the dynamic system. RESULTS: The complexity of torso movement dynamics required at least 5 embedded dimensions, which suggests that stability components of lumbar lordosis may be empirically measurable in addition to global stability of trunk dynamics. Repeated trajectories from fast paced movements diverged more quickly than slower movement, indicating that local dynamic stability is limited in fast movements. Movements in the midsagittal plane showed higher multidimensional kinematic divergence than asymmetric movements. CONCLUSION: Nonlinear dynamic systems analyses were successfully applied to empirically measured data, which were used to characterize the neuromuscular control of stability during repetitive dynamic trunk movements. Movement pace and movement direction influenced the control of spinal stability. These stability assessment techniques are recommended for improved workplace design and the clinical assessment of spinal stability in patients with low back pain.

Disturbed paraspinal reflex following prolonged flexion-relaxation and recovery.

STUDY DESIGN: Repeated measures experimental study of the effect of flexion-relaxation, recovery, and gender on paraspinal reflex dynamics. OBJECTIVE: To determine the effect of prolonged flexion-relaxation and recovery time on reflex behavior in human subjects. SUMMARY OF BACKGROUND DATA: Prolonged spinal flexion has been shown to disturb the paraspinal reflex activity in both animals and human beings. Laxity in passive tissues of the spine from flexion strain may contribute to desensitization of mechanoreceptors. Animal studies indicate that recovery of reflexes may take up to several hours. Little is known about human paraspinal reflex behavior following flexion tasks or the recovery of reflex behavior following the flexion tasks. METHODS: A total of 25 subjects performed static flexion-relaxation tasks. Paraspinal muscle reflexes were recorded before and immediately after flexion-relaxation and after a recovery period. Reflexes were quantified from systems identification analyses of electromyographic response in relation to pseudorandom force disturbances applied to the trunk. RESULTS: Trunk angle measured during flexion-relaxation postures was significantly higher following static flexion-relaxation tasks (P < 0.001), indicating creep deformation of passive supporting structures in the trunk. Reflex response was diminished following flexion-relaxation (P < 0.029) and failed to recover to baseline levels during 16 minutes of recovery. CONCLUSION: Reduced reflex may indicate that the spine is less stable following prolonged flexion-relaxation and, therefore, susceptible to injury. The absence of recovery in reflex after a substantial time indicates that increased low back pain risk from flexion-relaxation may persist after the end of the flexion task.

Effect of lumbar extensor fatigue on paraspinal muscle reflexes.

Low back disorders are a frequent medical problem. Altered neuromuscular control of the spine has been associated with low back pain, and may contribute to its occurrence. The purpose of this study was to investigate the effect of lumbar extensor fatigue on reflex delay and amplitude in the paraspinal muscles. Ten healthy males (20-22 years of age) were subjected to an anteriorly-directed perturbation applied at the inferior margin of the scapulae while standing quietly before and after a lumbar extensor fatiguing protocol. The fatiguing protocol consisted of multiple sets of back extensions and intermittent isometric maximum voluntary contraction on a Roman chair for 14 min until 60% of unfatigued lumbar extensor MVC was reached. Reflexes were recorded from the paraspinal muscles at the level of L4. Results indicated the mean reflex delay was 60+/-18 ms and was not affected by fatigue (p=0.278). Reflex amplitude increased 36+/-32% with fatigue (p=0.017). The increase in reflex amplitude may reflect an attempt to compensate for losses in muscle force capacity with fatigue in order to maintain sufficient spinal stability. However, additional studies are necessary to investigate the mechanisms of this fatigue-related change in paraspinal reflex.

Active trunk stiffness increases with co-contraction.

Trunk dynamics, including stiffness, mass and damping were quantified during trunk extension exertions with and without voluntary recruitment of antagonistic co-contraction. The objective of this study was to empirically evaluate the influence of co-activation on trunk stiffness. Muscle activity associated with voluntary co-contraction has been shown to increase joint stiffness in the ankle and elbow. Although biomechanical models assume co-active recruitment causes increase trunk stiffness it has never been empirically demonstrated. Small trunk displacements invoked by pseudorandom force disturbances during trunk extension exertions were recorded from 17 subjects at two co-contraction conditions (minimal and maximal voluntary co-contraction recruitment). EMG data were recorded from eight trunk muscles as a baseline measure of co-activation. Increased EMG activity confirms that muscle recruitment patterns were different between the two co-contraction conditions. Trunk stiffness was determined from analyses of impulse response functions (IRFs) of trunk dynamics wherein the kinematics were represented as a second-order behavior. Trunk stiffness increased 37.8% (p < 0.004) from minimal to maximal co-activation. Results support the assumption used in published models of spine biomechanics that recruitment of trunk muscle co-contraction increases trunk stiffness thereby supporting conclusions from those models that co-contraction may contribute to spinal stability.

Repeatability of surface EMG during gait in children.

Although mean amplitude and ON-OFF timing of muscle recruitment and electromyography (EMG) activation during gait is achieved by an age of six to eight years in normally developing children, recruitment dynamics illustrated by the shape of the EMG waveform may require continued developmental practice to achieve a stable pattern. Previous analyses have quantified the repeatability of the EMG waveform in adult subjects, but EMG variability for a pediatric population may be significantly different. The goal of this study was to quantify intra-session and inter-session variability in the phasic EMG waveform patterns from the lower limb muscles during self-selected speeds of walking in healthy-normal children for comparison with adult variability in gait EMG. The variance ratio quantifies the repeatability of the integrated EMG waveform shape in a group of normally-developing children. Results reveal that between-session EMG waveform variability were similar in adult and pediatric populations, but within-session variability for the children was approximately twice the published value for adults. Clinical implications of this pediatric EMG variability suggest cautious interpretation of data from limited trial samples or inter-session changes in performance of gait data.