Effect of forward and backward sloped support surfaces on postural equilibrium and ankle muscles activity.

INTRODUCTION: Although sloped surfaces are common in daily living, most studies of body balance are carried out on flat surfaces, and few data are available for sloping angles below 14°. OBJECTIVES: The purpose of this study was to explore the effect of forward and backward sloping surfaces at 7° and 15° on postural equilibrium and the activity of flexor/extensor ankle muscles. METHODS: Fifteen healthy subjects (8 males and 7 females) (27.67 ± 3.9 years) underwent a posturographic examination associated with a surface electromyogram (EMG) of tibialis anterior (TA), soleus (Sol) and gastrocnemius medialis (GasM) under five conditions of support inclination: 0° (H0), backward inclination at 7° and 15° (DF7 and DF15), forward inclination at 7° and 15° (PF7 and PF15). RESULTS: Results showed that the center of pressure (CP) was shifted according to the surface slope, with a forward move in PF7 (p <0.001) and PF15 (p <0.001) and a backward move in DF7 (p <0.01) and in DF15 (p <0.001). The mean displacement of the CP along the anterior-posterior axis (Xm) was increased in DF15 (p <0.01) relative to the H0 condition but reduced in PF7 (p <0.01). The normalized EMG revealed higher values when the muscles were in a shortened position (PF7 for Sol, p <0.05; PF15 for GasM, p <0.01; DF15 for TA, p<0.01) and lower values of GasM and Sol when lengthened (DF15, p <0.05). CONCLUSION: Our findings indicate that standing on a backward sloped surface impairs body balance, while low-angle forward sloped surfaces might improve postural stability. Muscular activity variations of the ankle flexors/extensors, which are stretched or shortened, also seem to be related to the length-tension relationship of skeletal muscles.

Effect of Seat Backrest Inclination on the Muscular Pattern and Biomechanical Parameters of the Sit-to-Stand.

Objectives: The sit-to-stand (STS) transfer mobilizes an extended part of the kinematic chain throughout a postural phase characterized by a flexion of the trunk and a focal phase consisting of a whole-body extension. The aim of this study was to analyze the variations of the global muscular pattern and the biomechanical parameters in both phases, in relation with seat backrest inclination. Methods: Fifteen participants were asked to stand up from a seat with 5 backrest inclination settings and at 2 execution speeds. The ground reaction forces and the activity levels of fifteen muscles of the trunk and lower limbs were investigated. Results: Backrest-induced modifications were mainly observed in the postural phase: inclining the backrest backward increased the phase duration and the activity level of the sternocleidomastoideus and the rectus abdominis, while it reduced the activity of the tibialis anterior. It also allowed for an increased maximal anteroposterior velocity of the body center of mass. Higher execution speed led to increased and earlier muscular activities of many trunk and lower limbs muscles, predominantly in the postural phase. Discussion: Taken together, these results suggest that a greater backrest inclination increases the demand in the postural phase due to the increase of the upper body gravity torque about the ischial tuberosities, and requires an adaptation of muscular activity levels and timing, but with the same overall pattern. The kinetic energy gained during the longer excursion of the trunk may also require less activation of the lower limbs muscles involved in the generation of propulsive forces of the body.

Sit-to-Stand Muscular Activity for Different Seat Backrest Inclination Levels and Execution Speeds.

The sit-to-stand transfer can be separated into a postural phase (trunk flexion) and a focal phase (whole-body extension). The aim of this study was to analyze the as yet little known whole-body muscular activity characterizing each phase of this task and its variations with backrest inclination and execution speed. Fifteen muscles of the trunk and lower limbs of 10 participants were investigated using surface EMG. Results showed that backrest-induced modifications were mostly confined to the postural phase: reclining the backrest increased its duration and the activity level of the sternocleidomastoideus, the rectus and obliquus externus abdominis, and the semitendinosus. Speed-induced variations were also predominant during the postural phase, which was shortened with an increased activity of most muscles at maximal speed.

Short-Term Effects of Thoracic Spine Manipulation on the Biomechanical Organisation of Gait Initiation: A Randomized Pilot Study.

Speed performance during gait initiation is known to be dependent on the capacity of the central nervous system to generate efficient anticipatory postural adjustments (APA). According to the posturo-kinetic capacity (PKC) concept, any factor enhancing postural chain mobility and especially spine mobility, may facilitate the development of APA and thus speed performance. "Spinal Manipulative Therapy High-Velocity, Low-Amplitude" (SMT-HVLA) is a healing technique applied to the spine which is routinely used by healthcare practitioners to improve spine mobility. As such, it may have a positive effect on the PKC and therefore facilitate gait initiation. The present study aimed to investigate the short-term effect of thoracic SMT-HVLA on spine mobility, APA and speed performance during gait initiation. Healthy young adults (n = 22) performed a series of gait initiation trials on a force plate before ("pre-manipulation" condition) and after ("post-manipulation" condition) a sham manipulation or an HVLA manipulation applied to the ninth thoracic vertebrae (T9). Participants were randomly assigned to the sham (n = 11) or the HVLA group (n = 11).The spine range of motion (ROM) was assessed in each participant immediately after the sham or HVLA manipulations using inclinometers. The results showed that the maximal thoracic flexion increased in the HVLA group after the manipulation, which was not the case in the sham group. In the HVLA group, results further showed that each of the following gait initiation variables reached a significantly lower mean value in the post-manipulation condition as compared to the pre-manipulation condition: APA duration, peak of anticipatory backward center of pressure displacement, center of gravity velocity at foot-off, mechanical efficiency of APA, peak of center of gravity velocity and step length. In contrast, for the sham group, results showed that none of the gait initiation variables significantly differed between the pre- and post-manipulation conditions. It is concluded that HVLA manipulation applied to T9 has an immediate beneficial effect on spine mobility but a detrimental effect on APA development and speed performance during gait initiation. We suggest that a neural effect induced by SMT-HVLA, possibly mediated by a transient alteration in the early sensory-motor integration, might have masked the potential mechanical benefits associated with increased spine mobility.

Influence of Cervical Spine Mobility on the Focal and Postural Components of the Sit-to-Stand Task.

The aim of this study was to determine the influence of cervical spine mobility on the focal and postural components of the sit-to-stand transition, which represent the preparatory and execution phases of the task, respectively. Sixteen asymptomatic female participants (22 ± 3 years, 163 ± 0,06 cm, 57,5 ± 5 kg), free of any neurological or musculoskeletal disorders, performed six trials of the sit-to-stand task at maximum speed, in four experimental conditions varying the mobility of the cervical spine by means of three different splints. A six-channel force plate, which collected the reaction forces and moments applied at its top surface, was used to calculate the center of pressure displacements along the anterior-posterior and medial-lateral axes. The local accelerations of the head, spine, and pelvis, were assessed by three pairs of accelerometers, oriented along the vertical and anterior-posterior axes. Restriction of cervical spine mobility resulted in an increased duration of the focal movement, associated with longer and larger postural adjustments. These results suggest that restricted cervical spine mobility impairs the posturo-kinetic capacity during the sit-to-stand task, leading to a lower motor performance and a reorganization of the anticipatory postural adjustments. In a clinical context, it might be assumed that preserving the articular free play of the cervical spine might be useful to favor STS performance and autonomy.

Effect of Experimentally-Induced Trunk Muscular Tensions on the Sit-to-Stand Task Performance and Associated Postural Adjustments.

It has been shown that increased muscular activity along the trunk is likely to impair body balance, but there is little knowledge about its consequences on more dynamic tasks. The purpose of this study was to determine the effect of unilateral and bilateral increases of muscular tension along the trunk on the sit-to-stand task (STS) performance and associated anticipatory postural adjustments (APAs). Twelve healthy females (23 ± 3 years, 163 ± 0.06 cm, 56 ± 9 kg), free of any neurological or musculoskeletal disorders, performed six trials of the STS at maximum speed, in seven experimental conditions varying the muscular tension along each side of the trunk, using a specific bimanual compressive load paradigm. A six-channel force plate was used to calculate the coordinates of the center of pressure (CP) along the anterior-posterior and medial-lateral axes, and the kinematics of the head, spine and pelvis, were estimated using three pairs of uni-axial accelerometers. The postural and focal components of the task were assessed using three biomechanical parameters calculated from CP signals: the duration and magnitude of APAs, and the duration of focal movement (dFM). Results showed that beyond a given level, higher muscular tension along the trunk results in longer APAs, but with a stable duration of the focal movement. In addition, no significant variation of APAs and FM parameters was found between bilateral and unilateral increases of muscular tension. It was suggested that restricted mobility due to higher muscular tension along the trunk requires an adaptation of the programming of APAs to keep the same level of performance in the STS task. These findings may have implications in treatment strategies aimed at preserving functional autonomy in pathologies including a rise of muscular tension.

Effect of seat and table top slope on the biomechanical stress sustained by the musculo-skeletal system.

The purpose of this study was to assess the effect of table and seat slope on the biomechanical stress sustained by the musculo-skeletal system. Angular position of the head and trunk, and surface electromyography of eleven postural muscles were recorded while seated under different conditions of seat slope (0°, 15° forward) and table slope (0°, 20° backward). The specific stress sustained by C7-T1 joint was estimated with isometric torque calculation. The results showed that the backward sloping table was associated with a reduction of neck flexion and neck extensors EMG, contrasting with a concurrent overactivity of the deltoideus. The forward sloping chair induced an anterior pelvic tilt, but also a higher activity of the knee (vasti) and ankle (soleus) extensors. It was concluded that sloping chairs and tables favor a more erect posture of the spine, but entails an undesirable overactivity of upper and lower limbs muscles to prevent the body from sliding.

Sitting on a sloping seat does not reduce the strain sustained by the postural chain.

The objective of this study was to explore the effect of a forward sloping seat on posture and muscular activity of the trunk and lower limbs. To this aim, twelve asymptomatic participants were tested in six conditions varying seat slope (0°, 15° forward) and height (high, medium, low). Angular position of head, trunk and pelvis was assessed with an inertial orientation system, and muscular activity of 11 superficial postural muscles located in the trunk and lower limbs was estimated using normalized EMG. Results showed that a forward sloping seat, compared to a flat seat, induced a greater activity of the soleus (p<0.01), vastus lateralis (p<0.05) and vastus medialis (p<0.05), as well a lower hip flexion (p<0.01). In contrast, no significant variation of head, trunk and pelvis angular position was observed according to seat slope. It was concluded that forward sloping seats increase the load sustained by the lower limbs, without a systematic improvement of body posture.

Postural disturbances resulting from unilateral and bilateral diaphragm contractions: a phrenic nerve stimulation study.

Thoracoabdominal breathing movements are a complex source of postural disturbance, but there are contradictory reports in the literature with inspiration described as having either a backward or a forward disturbing effect. To elucidate the mechanisms underlying this phenomenon, the present study studied the postural disturbance caused by isolated contractions of the diaphragm. Eight male and four female healthy subjects followed an original paradigm of phrenic nerve stimulation (bilateral and unilateral) and "diaphragmatic" voluntary sniff maneuvers in the seated and standing postures. Center of gravity (CG) acceleration was calculated from force plate recordings, and respiratory kinematics were assessed with thoracic and abdominal sensor belts. CG and respiratory signals revealed that, while seated, bilateral phrenic stimulation and sniff maneuvers consistently produced expansion of the abdomen associated with a forward peak of CG acceleration. In the standing posture, the direction of the CG peak was reversed and always directed backward. Unilateral phrenic stimulation induced an additional medial-lateral acceleration of the CG, directed toward the nonactive side while seated, but in the opposite direction while standing. These results suggest that isolated diaphragmatic contractions produce a constant disturbing pattern for a given posture, but with opposite effects between standing and seated postures. This could be related to the different biomechanical configuration of the body in each posture, corresponding to distinct kinematic patterns of the osteoarticular chain. In addition, the lateral component of the CG acceleration induced by unilateral diaphragm contractions could be clinically relevant in patients with hemidiaphragm paralysis.

Does increased muscular tension along the torso disturb postural equilibrium more when it is asymmetrical?

The aim of this study was to determine whether increased muscular tension disturbs postural equilibrium more when it is asymmetrical. Ten healthy male subjects underwent a posturographic examination associated with an original uni and bilateral compressive load paradigm designed to set the active muscular tension at different controlled levels along each side of the torso. Respiratory kinematics were recorded by means of two sensing belts. Two electromyographic pre-tests were used to map out the main motor muscles of the task and to quantify the level of asymmetry induced by unilateral loads. The posturographic examination revealed that the mean deviation of the CP along the medial-lateral axis was significantly greater in unilateral than in bilateral compressive loads. It was suggested that increased muscular tension along the torso induces a more disturbing effect on posture when it is asymmetrical.

Does increased muscular tension along the torso impair postural equilibrium in a standing posture?

This paper focused on the relationship between active muscular tension along the torso and postural equilibrium while standing. Eleven healthy male subjects underwent a posturographic examination associated with a bimanual compression of a dynamometric bar, which was used to set the torso muscular activity at three different levels (0MVC, 20MVC, 40MVC). Electromyographic pre-tests identified the main superficial muscles of the compressive load as: pectoralis major, latissimus dorsi, thoracic and lumbar erector spinae. Kinematics of the chest wall was recorded by means of two sensing belts, in order to assess the respiratory component of the center of pressure (CP) signal. The analysis of time-domain stabilometric parameters showed that CP displacements were larger and faster in 40MVC that in 20MVC, with no variation between 0MVC and 20MVC. The respiratory component of the CP signal was not sensitive to the compressive load. It was concluded that increased muscular tension along the torso is likely to disturb postural equilibrium, but only when it exceeds a given level.

Respiratory disturbance to posture varies according to the respiratory mode.

The purpose of this study was to determine whether respiratory disturbance to posture varies as a function of the respiratory mode, i.e. thoracic or abdominal. To this aim, 10 healthy male subjects underwent a posturographic examination associated with a measurement of respiratory kinematics. Experimental conditions varied posture (sitting, standing) respiratory amplitude (quiet breathing, deep breathing) and respiratory mode (thoracic, abdominal). In addition to classical posturographic parameters, original peak detection algorithm and emergence parameter calculated from the Fast Fourier Transform were used to assess the respiratory component in CP displacements. Results showed that along the antero-posterior axis, time domain and frequency domain parameters were both significantly greater in thoracic breathing mode than in abdominal mode. It was concluded that respiratory kinematics have a more prominent disturbing effect on posture when they involve the rib cage rather than the abdomen.

Influence of base of support size on arm pointing performance and associated anticipatory postural adjustments.

The current study was designed to test the effect of changing the base of support (BoS) size in the initial posture on the performance of a pointing task and the associated "anticipatory postural adjustments" (APAs). Subjects performed series of arm pointing tasks at maximal velocity, from five postures that differed by the antero-posterior (AP) distance between the heels. This distance was increased stepwise from 0 cm (P0 condition) to 40 cm (P40 condition). Kinetics data were collected with a large force-plate, and kinematics data of the pointing were collected with a bi-axial accelerometer (AP and vertical direction) fixed at the wrist. ANOVA showed that the amplitude and the efficiency of the APAs, as well as the performance of the pointing, all statistically increased from P0 to P40 (with 0.0001

Does postural chain muscular stiffness reduce postural steadiness in a sitting posture?

This study investigated the effect of postural chain muscular stiffening on postural steadiness when it is rhythmically perturbed by respiration. It consisted of an analysis of centre of pressure (CP) displacements when constant sub-maximum pushing efforts were performed in a sitting posture. Muscular stiffness, assessed by surface electromyography (iEMG), was imposed at two controlled levels, using two intensities of pushing effort (20% and 40% of the maximum voluntary contraction: 20MVC and 40MVC). Lumbo-pelvic mobility was varied using two different support areas at the seat contact (100% and 30% of the ischio-femoral length: 100BP and 30BP). Respiratory disturbance to posture was varied using two respiratory rate conditions (quiet breathing (QB), which is the spontaneous rate, and fast breathing (FB) at a rate imposed by a metronome). The results demonstrated that an increased push effort was associated to a higher iEMG level, and induced greater mean deviation (X (p)) and sway path (SP) of antero-posterior CP displacements. It was concluded that postural muscle stiffness reduces postural steadiness. It was suggested that it could be related to a weaker compensation of respiratory disturbance to body posture.