The immediate and prolonged effects of military body armor on the relative timing of thorax and pelvis rotations during toe-touch and two-legged squat tasks.

Although military body armor is an effective life saver, it considerably loads more weight on the warfighters, increasing the risk of musculoskeletal injury. This study investigated the immediate and prolonged effects of wearing body armor on timing aspect of lumbo-pelvic coordination during the toe-touch (TT) and two-legged-squat (TLS) tests. A cross-over study design was used wherein twelve asymptomatic and gender-balanced individuals completed two experimental sessions with and without body armor. A session included two similar sets of tests, before and after exposure to a treadmill walk, containing a TT and a TLS test with ten cycles of fast bending and return. Reflective markers were attached on the participants to capture the kinematics of body segments in conjunction with a motion capture system. The mean absolute relative phase (MARP) and deviation phase (DP) between the thorax and pelvis were calculated for each test. The pre-walk MARP in the return was significantly larger with versus without body armor (p = 0.022), while there were no significant effects of body armor on the other outcome measures. In addition, the pre-walk MARP and DP in the bending and return, as well as the walk-induced changes in the MARP in the bending phase were significantly larger in TLS versus TT (p < 0.026). Therefore, using a body armor immediately made the lumbo-pelvic coordination less in-phase during return, but no prolonged effects were found. Further investigation is necessary to specify chances wearing a body armor increases the risk of musculoskeletal injuries in the lower back and lower extremities joints.

The relationship between indicators of lumbo-pelvic coordination and pain, disability, pain catastrophizing and depression in patients presenting with non-chronic low back pain.

This study examined associations and changes overtime in low back kinematics and disability, pain, pain catastrophizing, and depression and assessed whether associations and changes overtime varied between individuals who meet the classification criteria for chronic low back pain at 6 months and those who do not. Findings suggested that those persons with a higher ratio of lumbar contribution to thorax motion and smaller pelvic tilt during forward bending had higher scores on measures of disability, pain and pain catastrophizing. This same association was found in those who met classification criteria for chronic low back pain at 6 months. Opposing associations were found in the group not meeting classification criteria for chronic low back pain, specifically, increased pelvic tilt was positively associated with higher pain catastrophizing scores. Practitioner summary This study examined associations and changes overtime in low back kinematics and psychosocial and clinical factors and whether associations and changes overtime varied between individuals who meet the classification criteria for chronic low back pain at 6 months and those who do not, Results suggest that associations exist between psychological factors and kinematic changes during the time between an acute low back pain episode to meeting classification for chronic low back pain at 6 months.

Effects of School Backpacks on Spine Biomechanics During Daily Activities: A Narrative Review of Literature.

OBJECTIVE: The purpose of this narrative review is to summarize the effects of carrying school backpacks on spine and low-back biomechanics as a risk factor for low back pain in young individuals. BACKGROUND: Backpacks constitute a considerable daily load for schoolchildren. Consistently, a large number of children attribute their low back pain experience to backpack use. METHOD: A literature search was conducted using a combination of keywords related to the impact of carrying backpacks on lower back biomechanics. The references of each identified study were further investigated to identify additional studies. RESULTS: Twenty-two studies met inclusion criteria. A total of 1,159 people aged 7 to 27 years were included in the studies. The added load of a backpack and the changes in spinal posture when carrying a backpack impose considerable demand on internal tissues and likely result in considerable spinal loads. The findings included results related to the effects of backpack weight and position on trunk kinematics and spine posture as well as trunk muscle activity during upright standing, walking, and ascending and descending stairs. CONCLUSION: Backpack-induced changes in trunk kinematics for a given activity reflect alterations in mechanical demand of the activity on the lower back that should be balanced internally by the active and passive responses of lower back tissues. Although the reported alterations in trunk muscle activities and lumbar posture are indications of changes in the active and passive response of the lower back tissues, the resultant effects on spinal load, that is, an important causal factor for low back pain, remains to be investigated in the future. A knowledge of backpack-induced changes in spinal loads can inform design of interventions aimed at reduction of spinal load via improved backpack design or limitation on carrying duration. APPLICATION: This narrative review is intended to serve as an educational article for students and trainees in ergonomics and occupational biomechanics.

A prospective study of lumbo-pelvic coordination in patients with non-chronic low back pain.

Despite the current knowledge about abnormalities in the lumbo-pelvic coordination of patients with non-specific low back pain (LBP), it is unclear how such abnormalities change with time. Timing and magnitude aspects of lumbo-pelvic coordination during a trunk forward bending and backward return task along with subjective measures of pain and disability were collected at three-time points over a six-month period from 29 patients who had non-chronic LBP at the time of enrollment in the study. To enable investigation of abnormalities in lumbo-pelvic coordination of patients, we also included lumbo-pelvic coordination data of age and gender-matched back healthy individuals from an earlier study of our group. Finally, differences in lumbo-pelvic coordination between patients with moderate-severe LBP (i.e., those whose level of pain was ≥ 4 (out of 10) at all three data collection sessions; n = 8) and patients with low-moderate LBP (n = 21) were investigated. There were clear distinctions in measures of lumbo-pelvic coordination between patients with low-moderate and moderate-severe LBP. Contrary to our expectation, however, the abnormalities in magnitude aspects of lumbo-pelvic coordination were larger (F > 4.84, P < 0.012) in patients with low-moderate LBP. These abnormalities in patients with low-moderate LBP, compared to controls, included larger (>12°) pelvic and thoracic rotations as well as smaller (>10°) lumbar flexion. The abnormal lumbo-pelvic coordination of patients with non-specific LBP, observed at baseline, persisted (F < 1.96, P > 0.156) or worsen (F > 3.48, P < 0.04) over the course of study period despite significant improvement in their pain (18% decrease; F = 12.10, P < 0.001) and disability (10% decrease; F = 4.39, P = 0.017). Distinct but lingering abnormalities in lumbo-pelvic coordination, observed in patients with low-moderate and moderate-severe LBP, might have a role in persistence and/or relapse of symptoms in patients with non-specific LBP. Such inferences, however, should further be studied in future via investigation of the relationship between abnormalities in lumbo-pelvic coordination and clinical presentation of LBP.

Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation.

Larger trunk and pelvic motions in persons with (vs. without) lower limb amputation during activities of daily living (ADLs) adversely affect the mechanical demands on the lower back. Building on evidence that such altered motions result in larger spinal loads during level-ground walking, here we characterize trunk-pelvic motions, trunk muscle forces, and resultant spinal loads among sixteen males with unilateral, transfemoral amputation (TFA) walking at a self-selected speed both up ("upslope"; 1.06 ±â€¯0.14 m/s) and down ("downslope"; 0.98 ±â€¯0.20 m/s) a 10-degree ramp. Tri-planar trunk and pelvic motions were obtained (and ranges-of-motion [ROM] computed) as inputs for a non-linear finite element model of the spine to estimate global and local muscle (i.e., trunk movers and stabilizers, respectively) forces, and resultant spinal loads. Sagittal- (p = 0.001), frontal- (p = 0.004), and transverse-plane (p < 0.001) trunk ROM, and peak mediolateral shear (p = 0.011) and local muscle forces (p = 0.010) were larger (respectively 45, 35, 98, 70, and 11%) in upslope vs. downslope walking. Peak anteroposterior shear (p = 0.33), compression (p = 0.28), and global muscle (p = 0.35) forces were similar between inclinations. Compared to previous reports of persons with TFA walking on level ground, 5-60% larger anteroposterior and mediolateral shear observed here (despite ∼0.25 m/s slower walking speeds) suggest greater mechanical demands on the low back in sloped walking, particularly upslope. Continued characterization of trunk motions and spinal loads during ADLs support the notion that repeated exposures to these larger-than-normal (i.e., vs. level-ground walking in TFA and uninjured cohorts) spinal loads contribute to an increased risk for low back injury following lower limb amputation.

Trunk muscle forces and spinal loads in persons with unilateral transfemoral amputation during sit-to-stand and stand-to-sit activities.

BACKGROUND: Alterations and asymmetries in trunk motions during activities of daily living, involving lower extremities, are suggested to cause higher spinal loads in persons with unilateral lower limb amputation. Given the repetitive nature of most activities of daily living, knowledge of the amount of increase in spinal loads is important for designing interventions aimed at prevention of secondary low back pain due to potential fatigue failure of spinal tissues. The objective of this study was to determine differences in trunk muscle forces and spinal loads between persons with and without lower limb amputation when performing sit-to-stand and stand-to-sit tasks. METHODS: Kinematics of the pelvis and thorax, obtained from ten males with unilateral transfemoral lower limb amputation and 10 male uninjured controls when performing sit-to-stand and stand-to-sit activities, were used within a non-linear finite element model of the spine to estimate trunk muscle forces and resultant spinal loads. FINDINGS: The peak compression force, medio-lateral (only during stand-to-sit), and antero-posterior shear forces were respectively 348 N, 269 N, and 217 N larger in person with vs. without amputation. Persons with amputation also experienced on average 171 N and 53 N larger mean compression force and medio-lateral shear force, respectively. INTERPRETATION: While spinal loads were larger in persons with amputation, these loads were generally smaller than the reported threshold for spinal tissue injury. However, a rather small increase in spinal loads during common activities of daily living like walking, sit-to-stand, and stand-to-sit may nevertheless impose a significant risk of fatigue failure for spinal tissues due to the repetitive nature of these activities.

Alterations in trunk bending stiffness following changes in stability and equilibrium demands of a load holding task.

The contribution of the trunk neuromuscular system (TNS) to spine stability has been shown in earlier studies by characterizing changes in antagonistic activity of trunk muscles following alterations in stability demands of a task. Whether and/or how much such changes in the response of TNS to alteration in stability demand of the task alter spinal stiffness remains unclear. To address this research gap, a repeated measure study was conducted on twenty gender-balanced asymptomatic individuals to evaluate changes in trunk bending stiffness throughout the lumbar spine's range of flexion following alterations in both stability and equilibrium demands of a load holding task. Trunk bending stiffness was determined using trunk stiffness tests in upright posture on a rigid metal frame under different equilibrium and stability demands on the lower back. Increasing the stability demand by increasing the height of lifted load ∼30 cm only increased trunk bending stiffness (∼39%) over the lower range of lumbar flexion and under the low equilibrium demand condition. Similarly, increasing the equilibrium demand of the task by increasing the weight of lifted load by 3.5 kg only increased trunk bending stiffness (55%) over the low range of lumbar flexion and under the low stability demand condition. Our results suggest a non-linear relationship between changes in stability and equilibrium demands of a task and the contribution of TNS to trunk bending stiffness. Specifically, alterations in TNS response to changes in stability and equilibrium demand of a given task will increase stiffness of the trunk only if the background stiffness is low.

The effects of backpack type on lumbo-pelvic coordination during trunk bending and return tasks.

Backpacks with ergonomic features are recommended to mitigate the risk of developing low back pain due to carrying a heavy school backpack. A repeated measure study was conducted on 40 college-age students to investigate the immediate changes in magnitude and timing aspects of lumbo-pelvic coordination when carrying an ergonomically modified vs. a normal backpack relative to no backpack condition during trunk forward bending and backward return tasks. We found a smaller reduction in the thoracic range of rotation, an increase vs. a decrease in pelvic range of rotation and a larger reduction in lumbar flexion for a modified vs. a normal backpack. Furthermore, during the forward bending, a less in-phase motion for the modified backpack was observed. Our results suggest that participants have likely experienced larger spinal loads with the modified backpack; a conclusion that should be investigated in future to determine whether ergonomic backpacks can reduce the risk of low back pain in children. Practitioner summary: Research participants performed trunk bending and return closer to their habitual way under modified versus normal school backpack. From an equilibrium point of view, therefore, individuals are likely experiencing larger spinal loads during activities of daily living with a modified backpack. However, such a conclusion may change when considering stability requirements.

Walking speed differentially alters spinal loads in persons with traumatic lower limb amputation.

Persons with lower limb amputation (LLA) perceive altered motions of the trunk/pelvis during activities of daily living as contributing factors for low back pain. When walking (at a singular speed), larger trunk motions among persons with vs. without LLA are associated with larger spinal loads; however, modulating walking speed is necessary in daily life and thus understanding the influences of walking speed on spinal loads in persons with LLA is of particular interest here. Three-dimensional trunk-pelvic kinematics, collected during level-ground walking at self-selected (SSW) and two controlled speeds (∼1.0 and ∼1.4 m/s), were obtained for seventy-eight participants: 26 with transfemoral and 26 with transtibial amputation, and 26 uninjured controls (CTR). Using a kinematics-driven, non-linear finite element model of the lower back, the resultant compressive and mediolateral/anteroposterior shear loads at the L5/S1 spinal level were estimated. Peak values were extracted and compiled. Despite walking slower at SSW speeds (∼0.21 m/s), spinal loads were 8-14% larger among persons with transfemoral amputation vs. CTR. Across all participants, peak compressive, mediolateral, and anteroposterior shear loads increased with increasing walking speed. At the fastest (vs. slowest) controlled speed, these increases were respectively 24-84% and 29-77% larger among persons with LLA relative to CTR. Over time, repeated exposures to these increased spinal loads, particularly at faster walking speeds, may contribute to the elevated risk for low back pain among persons with LLA. Future work should more completely characterize relative risk in daily life between persons with vs. without LLA by analyzing additional activities and tissue-level responses.

A model-based approach for estimation of changes in lumbar segmental kinematics associated with alterations in trunk muscle forces.

The kinematics information from imaging, if combined with optimization-based biomechanical models, may provide a unique platform for personalized assessment of trunk muscle forces (TMFs). Such a method, however, is feasible only if differences in lumbar spine kinematics due to differences in TMFs can be captured by the current imaging techniques. A finite element model of the spine within an optimization procedure was used to estimate segmental kinematics of lumbar spine associated with five different sets of TMFs. Each set of TMFs was associated with a hypothetical trunk neuromuscular strategy that optimized one aspect of lower back biomechanics. For each set of TMFs, the segmental kinematics of lumbar spine was estimated for a single static trunk flexed posture involving, respectively, 40° and 10° of thoracic and pelvic rotations. Minimum changes in the angular and translational deformations of a motion segment with alterations in TMFs ranged from 0° to 0.7° and 0 mm to 0.04 mm, respectively. Maximum changes in the angular and translational deformations of a motion segment with alterations in TMFs ranged from 2.4° to 7.6° and 0.11 mm to 0.39 mm, respectively. The differences in kinematics of lumbar segments between each combination of two sets of TMFs in 97% of cases for angular deformation and 55% of cases for translational deformation were within the reported accuracy of current imaging techniques. Therefore, it might be possible to use image-based kinematics of lumbar segments along with computational modeling for personalized assessment of TMFs.

Mechanical demands on the lower back in patients with non-chronic low back pain during a symmetric lowering and lifting task.

There is limited information in the literature related to the lower back loading in patients with LBP, particularly those with non-chronic LBP. Toward addressing such a research gap, a case-control study was conducted to explore the differences in lower back mechanical loads between a group of females (n=19) with non-chronic, non-specific LBP and a group of asymptomatic females (n=19). The differences in lower back mechanical loads were determined when participants completed one symmetric lowering and lifting of a 4.5kg load at their preferred cadence. The axial, shearing, and moment components of task demand at the time of peak moment component as well as measures of peak trunk kinematics were analyzed. Patient vs. asymptomatic group performed the task with smaller peak thoracic rotation and peak lumbar flexion. While no differences in the moment component of task demand on the lower back between the patients and controls were found, the shearing (40-50 age group) and axial components of task demand were, respectively, larger and smaller in patients vs. CONTROLS: Whether alterations in lower back loads in patients with non-chronic LBP are in response to pain or preceded the pain, the long-term exposure to abnormal lower back mechanics may adversely affect spinal structure and increase the likelihood of further injury or pain. Therefore, the underlying reason(s) as well as the potential consequence(s) of such altered lower back mechanics in patients with non-chronic LBP should to be further investigated.

Activity of Erector Spinae During Trunk Forward Bending and Backward Return: The Effects of Age.

Electromyography (EMG)-based measures of the trunk muscles behavior have been used for objective assessment of biomechanical impairments in patients with low back pain (LBP); yet the literature on normal age-related differences in such measures is scant. A cross-sectional study was designed to assess age-related differences in activity of trunk extensors during forward bending and backward return. Sixty asymptomatic individuals were recruited to form five gender-balanced age groups between 20 and 70 years old. Participants completed two sets of trunk forward bending and backward return task using self-selected and fast motion paces. For bending and return phases of each task, the normalized lumbar flexion angles corresponding to different event times of erector spinae activity along with the peak normalized and non-normalized EMG activities of erector spinae were calculated. The mean normalized and non-normalized EMG activities of erector spinae during the entire task also were calculated. There was no age-related difference in normalized lumbar flexion angles corresponding to different event times of erector spinae activity. However, the peak normalized EMG activity during forward bending and backward return as well as the mean normalized EMG activity during the entire task were found to be larger in older vs. younger individuals. Given the suggested unreliability of normalized EMG in elders and considering that we did not find any age-related differences in non-normalized EMG activity of erector spinae, our results do not strongly support the existence of normal age-related differences in EMG profile of erector spinae during forward bending and backward return. Therefore, when interpreting EMG-based measures of trunk muscles behavior for identification of biomechanical impairment in patients with LBP, potential abnormalities in EMG activity of trunk muscles may not be attributed to patient's age.

Timing and magnitude of lumbar spine contribution to trunk forward bending and backward return in patients with acute low back pain.

Alterations in the lumbo-pelvic coordination denote changes in neuromuscular control of trunk motion as well as load sharing between passive and active tissues in the lower back. Differences in timing and magnitude aspects of lumbo-pelvic coordination between patients with chronic low back pain (LBP) and asymptomatic individuals have been reported; yet, the literature on lumbo-pelvic coordination in patients with acute LBP is scant. A case-control study was conducted to explore the differences in timing and magnitude aspects of lumbo-pelvic coordination between females with (n=19) and without (n=19) acute LBP. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at preferred and fast paces. The amount of lumbar contribution to trunk motion (as the magnitude aspect) as well as the mean absolute relative phase (MARP) and deviation phase (DP) between thoracic and pelvic rotations (as the timing aspect) of lumbo-pelvic coordination were calculated. The lumbar contribution to trunk motion in the 2nd and the 3rd quarters of both forward bending and backward return phases was significantly smaller in the patient than the control group. The MARP and the DP were smaller in the patient vs. the control group during entire motion. The reduced lumbar contribution to trunk motion as well as the more in-phase and less variable lumbo-pelvic coordination in patients with acute LBP compared to the asymptomatic controls is likely the result of a neuromuscular adaptation to reduce painful deformation and to protect injured lower back tissues.

Comparison of lumbo-pelvic kinematics during trunk forward bending and backward return between patients with acute low back pain and asymptomatic controls.

BACKGROUND: Prior studies have reported differences in lumbo-pelvic kinematics during a trunk forward bending and backward return task between individuals with and without chronic low back pain; yet, the literature on lumbo-pelvic kinematics of patients with acute low back pain is scant. Therefore, the purpose of this study was set to investigate lumbo-pelvic kinematics in this cohort. METHODS: A case-control study was conducted to investigate the differences in pelvic and thoracic rotation along with lumbar flexion as well as their first and second time derivatives between females with and without acute low back pain. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at self-selected and fast paces. FINDINGS: Compared to controls, individuals with acute low back pain had larger pelvic range of rotations and smaller lumbar range of flexions. Patients with acute low back pain also adopted a slower pace compared to asymptomatic controls which was reflected in smaller maximum values for angular velocity, deceleration and acceleration of lumbar flexion. Irrespective of participant group, smaller pelvic range of rotation and larger lumbar range of flexion were observed in younger vs. older participants. INTERPRETATION: Reduced lumbar range of flexion and slower task pace, observed in patients with acute low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation.

Lumbar contribution to the trunk forward bending and backward return; age-related differences.

Age-related differences in lumbar contribution to the trunk motion in the sagittal plane were investigated. Sixty individuals between 20-70 years old in five gender-balanced age groups performed forward bending and backward return with slow and fast paces. Individuals older than 50 years old, irrespective of the gender or pace, had smaller lumbar contribution than those younger than this age. The lumbar contribution to trunk motion was also smaller in female participants than male participants, and under fast pace than under the slow pace. Age-related differences in lumbar contributions suggest the synergy between the active and passive lower back tissues is different between those above and under 50 years old, differences that are likely to affect the lower back mechanics. Therefore, detailed modelling should be conducted in future to find the age-related differences in the lower back mechanics for tasks involving large trunk motion. Practitioner Summary: Lumbar contribution to the sagittal trunk motion was observed to be smaller in individuals above 50 years old than those below this age. This could be an indication of a likely change in the synergy between the active and passive lower back tissues, which may disturb the lower back mechanics.

Age-related differences in the timing aspect of lumbopelvic rhythm during trunk motion in the sagittal plane.

Forward bending and backward return of the human trunk in the sagittal plane are associated with a specific lumbopelvic rhythm, which consists of magnitude and timing aspects. In this study, the age-related differences in the timing aspect of lumbopelvic rhythm were investigated using the continuous relative phase method. Specifically, the mean absolute relative phase (MARP) between the thoracic and pelvic motions as well as variation in MARP under repetitive motions, denoted by deviation phase (DP), were characterized in sixty participants between 20 and 70years old. MARP and DP were determined for trunk forward bending and backward return tasks with self-selected slow and fast paces. The MARP and DP were both smaller (p=0.003, p<0.001 respectively) in the older versus younger age participants with no gender-related difference. In fast versus slow pace task, the MARP was smaller (p<0.001) only in forward bending, whereas the DP was smaller (p<0.001) in both the forward bending and backward return. A more in-phase and more stable lumbopelvic rhythm denoted respectively by smaller MARP and DP in older versus younger individuals maybe a neuromuscular strategy to protect the lower back tissues from excessive strain, in order to reduce the risk of injury.

Age-related differences in trunk muscle reflexive behaviors.

Reports of larger passive and similar intrinsic trunk stiffness in older vs. younger populations suggest a diminishing demand for reflexive contributions of trunk muscles to spinal stability with aging. It remains unclear, though, whether such diminishing demands result in deterioration of trunk muscle reflexive behaviors. A cross-sectional study was completed to assess age-related differences in the latency and likelihood of trunk muscle reflexive responses to sudden perturbations. Sixty healthy individuals, aged 20-70 years, were recruited to form five equal-sized and gender-balanced age groups. Using a displacement-control, sudden perturbation paradigm, the latency and likelihood of trunk muscle reflexive responses to sudden perturbations were estimated, and the influences of age, gender, and level of effort (20% versus 30% of maximum voluntary exertion-MVE) were evaluated. There were no consistent age-related differences found in any of the measures of trunk muscle reflexive behavior. However, the latency of muscle response to perturbation was generally higher among older individuals, and this difference was significant in the condition involving 30% MVE effort. With an increase in level of effort (from 20% to 30% of MVE), there was a ~7% increase in the latency of trunk muscle responses to anteriorly-directed perturbations as well as ~ 15% (21%) decrease (increase) in response likelihood during anteriorly (posteriorly) directed perturbations. Furthermore, the reflexive response likelihood of trunk muscles was 28% (58%) larger (smaller) in female vs. male participants during anteriorly (posteriorly) directed perturbations. Our results did not, in general, support the hypothesis of an age-related decay in reflexive trunk muscle behaviors. Larger reflexive responses were associated with lower trunk intrinsic stiffness among females and during a lower level of effort, suggesting a secondary role for reflexive responses in spinal stability. Such secondary compensatory responses appear, however, to be consistent over a wide age range.

Viscoelastic Response of the Human Lower Back to Passive Flexion: The Effects of Age.

Low back pain is a leading cause of disability in the elderly. The potential role of spinal instability in increasing risk of low back pain with aging was indirectly investigated via assessment of age-related differences in viscoelastic response of lower back to passive deformation. The passive deformation tests were conducted in upright standing posture to account for the effects of gravity load and corresponding internal tissues responses on the lower back viscoelastic response. Average bending stiffness, viscoelastic relaxation, and dissipated energy were quantified to characterize viscoelastic response of the lower back. Larger average bending stiffness, viscoelastic relaxation and dissipated energy were observed among older vs. younger participants. Furthermore, average bending stiffness of the lower back was found to be the highest around the neutral standing posture and to decrease with increasing the lower back flexion angle. Larger bending stiffness of the lower back at flexion angles where passive contribution of lower back tissues to its bending stiffness was minimal (i.e., around neutral standing posture) highlighted the important role of active vs. passive contribution of tissues to lower back bending stiffness and spinal stability. As a whole our results suggested that a diminishing contribution of passive and volitional active subsystems to spinal stability may not be a reason for higher severity of low back pain in older population. The role of other contributing elements to spinal stability (e.g., active reflexive) as well as equilibrium-based parameters (e.g., compression and shear forces under various activities) in increasing severity of low back pain with aging should be investigated in future.

Age-related differences in trunk intrinsic stiffness.

Age-related differences in trunk intrinsic stiffness, as an important potential contributor to spinal stability, were investigated here because of: (1) the role of spinal instability in low back pain (LBP) development; (2) the increasing prevalence of LBP with age, and (3) the increasing population of older people in the workforce. Sixty individuals aged 20-70 years, in five equal-size age groups, completed a series of displacement-controlled perturbation tests in an upright standing posture while holding four different levels of trunk extension efforts. In addition to examining any age-related difference in trunk intrinsic stiffness, the current design assessed the effects of gender, level of effort, and any differences in lower back neuromuscular patterns on trunk intrinsic stiffness. No significant differences in trunk intrinsic stiffness were found between the age groups. However, stiffness was significantly larger among males and increased with the level of extension effort. No influences of differences in neuromuscular pattern were observed. Since the passive contribution of trunk tissues in the upright standing posture is minimal, our values of estimated trunk intrinsic stiffness primarily represent the volitional contribution of the lower back musculoskeletal system to spinal stability. Therefore, it seems unlikely that the alterations in volitional behavior of the lower back musculature, caused by aging (e.g., as reflected in reduced strength), diminish their contributions to the spinal stability.

Persons with unilateral transfemoral amputation experience larger spinal loads during level-ground walking compared to able-bodied individuals.

BACKGROUND: Persons with lower limb amputation walk with increased and asymmetric trunk motion; a characteristic that is likely to impose distinct demands on trunk muscles to maintain equilibrium and stability of the spine. However, trunk muscle responses to such changes in net mechanical demands, and the resultant effects on spinal loads, have yet to be determined in this population. METHODS: Building on a prior study, trunk and pelvic kinematics collected during level-ground walking from 40 males (20 with unilateral transfemoral amputation and 20 matched controls) were used as inputs to a kinematics-driven, nonlinear finite element model of the lower back to estimate forces in 10 global (attached to thorax) and 46 local (attached to lumbar vertebrae) trunk muscles, as well as compression, lateral, and antero-posterior shear forces at all spinal levels. FINDINGS: Trunk muscle force and spinal load maxima corresponded with heel strike and toe off events, and among persons with amputation, were respectively 10-40% and 17-95% larger during intact vs. prosthetic stance, as well as 6-80% and 26-60% larger during intact stance relative to controls. INTERPRETATION: During gait, larger spinal loads with transfemoral amputation appear to be the result of a complex pattern of trunk muscle recruitment, particularly involving co-activation of antagonistic muscles during intact limb stance; a period when these individuals are confident and likely to use the trunk to assist with forward progression. Given the repetitive nature of walking, repeated exposure to such elevated loading likely increases the risk for low back pain in this population.