Cervical electromyogram profile differences between patients of neck pain and control.

STUDY DESIGN: A comparative analysis of electromyogram (EMG) signals of patients of cervical pain and normal controls. OBJECTIVES: To determine the differences between frequency and time domain parameters of EMG signals of patients of cervical pain and normal controls. SUMMARY OF BACKGROUND DATA: No diagnostic technique has emerged as a satisfactory tool for identification of spinal pain. METHOD: Seventeen male and 17 female chronic neck pain patients without cervical radiculopathy were recruited through neurology EMG clinic. The controls consisted of 30 male and 33 female subjects with no history of neck pain in the past 12 months. All subjects performed flexion, left anterolateral flexion, left lateral flexion, left posterolateral extension, and extension to pain threshold/20% maximum voluntary contraction and pain tolerance/maximum voluntary contraction in random order. The descriptive statistics for body weight normalized strength, normalized peak EMG, time to onset, time to peak, median frequency, mean power frequency, and frequency bands were calculated. These variables were subjected to analysis of variance and logistic regression to distinguish between patients and controls. RESULTS: The normalized peak EMG of patients was significantly greater than those of controls in both maximal and submaximal exertions (P < 0.01). Whereas there was no consistent pattern in time to peak EMG, the time to onset of EMG revealed that the left sternocleidomastoid was always recruited before the onset of torque. A lack of significant difference in the median frequency of the 2 samples indicates that the pain did not disturb the muscle conduction velocity. Using discriminant logistic regression on frequency domain and time domain parameters, up to 97% of patients and controls were correctly classified with the resubstitution method. CONCLUSION: Surface EMG can be used successfully in distinguishing chronic pain patients and controls, and efficacy of treatment regimes.

Measures of localized spinal muscle fatigue.

The objective of this study was to determine the best variable, if any, to indicate the level of localized muscle fatigue. Six male and six female subjects were studied while they exerted their maximal voluntary contraction and 40% of maximal voluntary contraction of spinal extensors in an isometric lifting activity. The electromyography (EMG) of erectores spinae at thoracic and lumbar levels was measured bilaterally. Also, the muscle bed blood volume, level of blood oxygenation to erector spinae at L3 level and heart rate were measured. The initial and final values of subjective feelings of fatigue through visual analogue score, rate of perceived exertions and body part discomfort rating were recorded. The mean maximal voluntary contraction forces for males and females were 899 (238) N and 431 (135) N respectively. The mean durations of hold in maximal voluntary fatiguing contraction were 68.1 (39.9) s and 72.3 (37.0) s for men and women respectively. By the end of the hold the force declined to 52% for males and 62% for females. The EMG amplitudes and median frequencies also progressively declined (p < 0.01). ANOVA revealed that the task percentile values of all variables were significantly different (p < 0.01). Gender had a significant main effect (p < 0.01). The correlation coefficients between force and other individual variables were weak to modest, but significant (p < 0.001). None of the single variables predicted fatigue reliably for either gender and levels of contraction. The regression equations developed were highly significant (p < 0.01) and they explained 96 to 98% of variance in both genders and contractions.

Torque and EMG in rotation extension of the torso from pre-rotated and flexed postures.

BACKGROUND: Back injury is a common place in our society. Up to two-thirds of back injuries have been associated with trunk rotation. However, the torque production ability with a rotated spine and electromyographic activity of trunk muscles in such efforts is poorly understood. Therefore, the objectives of this study are to study torque production capacity of variously rotated and flexed trunk and to measure the EMG of selected trunk muscles in these activities. METHODS: Nineteen normal young subjects (7 males and 12 females) were recruited. Subjects were stabilized on a posture-stabilizing platform and were instructed to assume a flexed and right rotated posture (20 degrees , 40 degrees and 60 degrees of rotation and 20 degrees , 40 degrees and 60 degrees of flexion) in a random order. The subjects were asked to exert their maximal voluntary contraction in the asymmetric plane of rotation-extension for a period of 5s. The surface EMG of the external and internal obliques, rectus abdominis, latissimus dorsi, erector spinae at the 10th thoracic and 3rd lumbar vertebral levels was recorded bilaterally along with the torque generated. FINDINGS: Whereas the torque generated was significantly affected by both rotation and extension in both genders (P<0.001), the EMG was independent of rotation but affected by flexion in females only (P<0.01). The torques produced by both genders in each of the nine postures was significantly different from each other (P<0.001). The EMG demonstrated a trend of increase with increasing rotation and flexion. The response surfaces of normalized peak EMG of the right external oblique and internal oblique was somewhat similar, indicating a rotator torque and a stabilizing effect. The left latissimus dorsi and right external oblique provided the rotational torque and the right erector spinae provided the extensor effort. Since the rotation-extension was performed in the plane of asymmetry, the effort required the recruitment of muscles involved in left rotation, stability of rotated spine and an extensor effort. INTERPRETATION: The torque production capacity of the human trunk is posture dependent and declines with increasing rotation. However, with increasing rotation and flexion, the magnitude of EMG increases. This implies that with increasing asymmetry, it requires more muscle effort (thus tissue stress) to generate less torque. Increasing asymmetry tends to weaken the system and may enhance chances of injury.

Low back problems and possible improvements in nursing jobs.

AIM: This paper reports a study that aimed to evaluate the workload, to identify problems leading to the higher incidence rate of work-related low back injury among nurses in the orthopaedic and intensive care unit departments of the hospital, and to gather information about improvements that the nurses would like in the workplace. BACKGROUND: The literature shows that low back injuries are common among nurses, and intervention programmes are needed to address this problem. METHOD: The hospital injury records were examined in a retrospective study. In addition, a validated questionnaire was administered between January and May 2005 to 47 nurses (23 orthopaedic and 24 intensive care nurses). The questionnaire contained questions on workload, history of back injuries, problems, possible solutions and psychophysical measures of exertion. FINDINGS: The life-time incidence and point prevalence of low back pain were 65% and 30%, respectively, in orthopaedic nurses, and 58% and 25%, respectively, in the intensive care nurses. The mean weight handled was reported to be 47 +/- 30 kg by the orthopaedic nurses and 26 +/- 10 kg by the intensive care nurses. The low back scored highest for body-part discomfort - 4.6 and 4.0, respectively, on a 10-point scale. The rate of perceived job exertion was 6.7 +/- 1.8 (very strong), and 5.8 +/- 1.9 (strong) on Borg's 10-point scale. The total effort required by the job, rated on Visual Analogue Scales, was 67 +/- 14% and 68 +/- 15% of the maximum, respectively. The Borg scores and the total effort according to the Visual Analogue Scale, and the Borg scores and force effort on the Visual Analogue Scale were moderately correlated (r = 0.53, P < 0.01 for both comparisons). CONCLUSION: The methodology proposed here is practical for job evaluation and to design a participatory ergonomic intervention aiming at reducing low back injuries in nursing jobs. There are workload differences between nursing jobs. Lifting devices, biomechanical training, bigger rooms, adequate set-up and additional staff are suggested improvements.

Analysis of right anterolateral impacts: the effect of trunk flexion on the cervical muscle whiplash response.

BACKGROUND: The cervical muscles are considered a potential site of whiplash injury, and there is a need to understand the cervical muscle response under non-conventional whiplash impact scenarios, including variable body position and impact direction. There is no data, however, on the effect of occupant position on the muscle response to frontal impacts. Therefore, the objective of the study was to measure cervical muscle response to graded right anterolateral impacts. METHODS: Twenty volunteers were subjected to right anterolateral impacts of 4.3, 7.8, 10.6, and 12.8 m/s(2) acceleration with their trunk flexed forward 45 degrees and laterally flexed right or left by 45 degrees. Bilateral EMG of the sternocleidomastoids, trapezii, and splenii capitis and acceleration of the sled, torso, and head were measured. RESULTS AND DISCUSSION: With either direction of trunk flexion at impact, the trapezius EMGs increased with increasing acceleration (p < 0.05). Time to onset of the electromyogram and time to peak electromyogram for most muscles showed a trend towards decreasing with increasing acceleration. With trunk flexion to the left, the left trapezius generated 38% of its maximal voluntary contraction (MVC) EMG, while the right trapezius generated 28% of its MVC EMG. All other muscles generated 25% or less of this measure (25% for the left splenius capitis, 8% for the right splenius capitis, 6% for the left sternocleidomastoid, and 2% for the left sterncleidomastoid). Conversely, with the trunk flexed to the right, the right trapezius generated 44% of its MVC EMG, while the left trapezius generated 31% of this value, and all other muscles generated 20% or less of their MVC EMG (20% for the left splenius capitis, 14% for the right splenius capitis, 4% for both the left and right sternocleidomastoids). CONCLUSION: When the subject sits with trunk flexed out of neutral posture at the time of anterolateral impact, the cervical muscle response is dramatically reduced compared to frontal impacts with the trunk in neutral posture. In the absence of bodily impact, the flexed trunk posture appears to produce a biomechanical response that would decrease the likelihood of cervical muscle injury in low velocity impacts.

An observational electromyography study of the effect of trunk flexion in low-velocity frontal whiplash-type impacts.

OBJECTIVE: To examine the effect of forward and lateral trunk flexion on the cervical electromyogram and head kinematic response to whiplash-type frontal impacts. DESIGN: Observational study of sled impacts. SETTING: Laboratory. PARTICIPANTS: Twenty healthy volunteers. INTERVENTION: Twenty volunteers were subjected to increasing low-velocity (<8km/h) frontal impacts of 4.4, 7.6, 10.3, and 13.3m/s(2) acceleration with trunk forward flexed by 45 degrees and laterally flexed to the right and left by 45 degrees . MAIN OUTCOME MEASURES: Bilateral electromyography of the sternocleidomastoids, trapezii, and splenii capitis and acceleration of the sled, torso, and head were recorded. RESULTS: With either direction of lateral trunk flexion at impact, the trapezii electromyographic activity increased with increasing acceleration (P<.05). With the trunk flexed to the left, the left trapezius generated 39% of its maximal voluntary contraction (MVC) electromyographic activity, while the right trapezius generated 31% of its MVC electromyographic activity. The left splenius (ipsilateral to leftward trunk flexion) generated 24% of its MVC electromyographic activity, with all other muscles generating 15% or less of this measure. With the trunk flexed to the right, the right trapezius generated 38% of its MVC electromyographic activity, while the left trapezius generated 32% of this value. Again, the ipsilateral (to trunk flexion) splenius capitis generated 27% of its MVC electromyographic activity, and all other muscles 11% or less of this measure. CONCLUSIONS: When subjects sit with trunk flexed out of neutral posture at the time of frontal impact, the cervical muscle response is low and unlikely to be injurious.

The effect of seat belt use on the cervical electromyogram response to whiplash-type impacts.

OBJECTIVE: The objective of this study was to determine the effect of a standard 3-point lap-and-shoulder seat belt and car seat on the electromyogram (EMG) response of the cervical muscles to increasing low-velocity impacts in comparison with that of a rigid seat and 5-point restraint. METHODS: Seventeen healthy volunteers were subjected to rear, frontal, right and left lateral and bilateral anterolateral, and posterolateral impacts with an acceleration varying from 4.4 to 16.8 m/s(2) while in a car seat with lap-and-shoulder seat belt. RESULTS: For rear-end impacts, whether straight on, right posterolateral, or left posterolateral, all muscles generated 50% or less of the maximal voluntary contraction (MVC) EMG. In straight-on rear impacts, the sternocleidomastoid was symmetrically the most active; however, in posterolateral impacts, the sternocleidomastoid contralateral to impact direction was more active than its counterpart. For a right lateral impact, at the highest acceleration, the left splenius capitis generated 47% of its MVC and the left trapezius did 46% of its MVC. In a left lateral impact, the right splenius capitis generated 48% of its MVC and the right trapezius did 57% of its MVC. In a straight-on frontal impact, the left trapezius generated 35% of its MVC and the right trapezius did 48% of its MVC. In a left anterolateral impact, the right splenius generated 60% of its MVC and the right trapezius did 66% of its MVC. Similarly, in a right anterolateral impact, the contralateral splenius muscle increased its activity to 52% of its MVC and the left trapezius was at 52% of its MVC. CONCLUSIONS: Compared with previously reported impact studies with a rigid seat and 5-point harness, the use of a 3-point lap-and-shoulder seat belt with a standard car seat did not appear to adversely affect cervical muscle response. In very-low-velocity and low-velocity impact experiments, seat belt and seat type may not significantly alter cervical EMG and kinematics.

The effect of a 3-point harness restraint and car seat in whiplash-type lateral impacts.

STUDY DESIGN: Seventeen healthy volunteers were subjected to right and left lateral impacts 5.0, 6.8, 9.2, and 16.8 m/s acceleration while positioned in a Volvo car seat with lap and shoulder seat belt restraint in laboratory setting. OBJECTIVES: The purpose of this study was to determine the effect of using a standard 3-point lap and shoulder seat belt and Volvo car seat on the response of the cervical muscles to increasing low-velocity lateral impacts. SUMMARY OF BACKGROUND DATA: A previous study of lateral impacts in a 5-point harness restraint with head and trunk in neutral posture suggests that the burden of impact is borne primarily by the splenius capitis muscle contralateral to the direction of impact. That study, however, used a nonstandard harness for automobiles, and other studies suggest that a lap-and-shoulder seat belt may increase the risk of whiplash injury. METHODS: Triaxial accelerometers recorded the acceleration of the 1) sled, 2) torso at the shoulder level, and 3) head of the participant, while bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis were also recorded. RESULTS: For participants experiencing a right or left lateral impact, the muscle responses increased with increasing levels of acceleration (P < 0.05). The time to onset and time to peak electromyogram for most muscles also showed a trend to progressively decrease with increasing levels of acceleration. The peak head accelerations relative to the sled ranged from 2.5 to 10.6 m/s. When the impact was a right lateral impact, at the highest sled acceleration, the left splenius capitis generated 47% of its maximal voluntary contraction (MVC), and the left trapezius also 46% of its MVC; the left and right sternocleidomastoid, right splenius capitis, and right trapezius generated 29% or less of their MVC. For the highest level of acceleration in a left lateral impact, the right splenius capitis generated 48% of its MVC and the right trapezius 57% of the MVC, the left and right sternocleidomastoid, left splenius capitis, and left trapezius generated 29% or less of their MVC. In both directions of impact, the contralateral splenius capitis and trapezius showed a statistically significant difference in the EMG response compared with other muscles (P < 0.05). For participants experiencing a frontal impact, whether straight-on, right or left anterolateral, the muscle responses increased with increasing levels of acceleration (P < 0.05). The time to onset and time to peak electromyogram for most muscles also showed a trend to progressively decrease with increasing levels of acceleration. In a straight-on frontal impact, the trapezii (TRPs) muscles showed the greatest EMG response compared with the remaining muscles (P < 0.05). CONCLUSIONS: Compared with previously reported impact studies with a 5-point harness and rigid seat, the use of a 3-point lap and shoulder seat belt with car seat does not appear to adversely affect the cervical muscle response. In very-low- and low-velocity impact experiments, seat belt and seat type may thus not be particularly relevant to cervical EMG and kinematics.

The effect of trunk flexion in healthy volunteers in rear whiplash-type impacts.

STUDY DESIGN: Twenty young, healthy volunteers in a laboratory were subjected to rear-end impacts 4.4, 7.9, 10.9, and 13.1 m/s acceleration with head rotation to right and left. OBJECTIVES: The purpose of this study was to determine the response of the cervical muscles to increasing low-velocity rear impacts when the head is rotated at the time of impact. SUMMARY OF BACKGROUND DATA: A previous study of rear impacts with head in neutral posture suggests that the burden of impact is borne primarily by the sternocleidomastoid muscles bilaterally. To improve automobile designs to prevent whiplash injury, we need to understand the response of the cervical muscles to whiplash-type perturbations in other conditions that mimic road collisions, such as when the head is rotated to the right and left at the time of rear-end impact. METHODS: Triaxial accelerometers recorded the acceleration of the sled, torso at the shoulder level, and head of the participant, while bilateral electromyograms (EMGs) of the sternocleidomastoids, trapezii, and splenii capitis were also recorded on 20 subjects (10 males and 10 females, mean age of 23.6 +/- 3 years) RESULTS: For participants experiencing a rear-end impact, whether having the head rotated to the left or right at the time of impact, the muscle responses increased with increasing levels of acceleration (P < 0.01). The time to onset and time to peak EMG for all muscles progressively decreased with increasing levels of acceleration (P < 0.01). Which muscle responded most to a whiplash-type neck perturbation was determined by the direction of head rotation. With the head rotated to the left, the right sternocleidomastoid generated 88% of its maximal voluntary contraction EMG (at least triple the response of other muscles). In comparison, the left sternocleidomastoid, both trapezii, and the splenii capitis generated on average only 10 to 30% of their maximal voluntary contraction EMG with head rotated to the left. On the other hand, with the head rotated to the right, the left sternocleidomastoid generated 94% of its maximal voluntary contraction EMG (again, at least triple the response of other muscles). CONCLUSIONS: If the head is rotated out of neutral posture at the time of rear impact, the injury risk tends to be greater for the sternocleidomastoid muscle contralateral to the side of rotation. Measures to prevent whiplash injury may have to account for the asymmetric response because many whiplash victims are expected to be looking to the left or right at the time of collision.

Cervical muscle response to head rotation in whiplash-type right lateral impacts.

OBJECTIVE: To determine the electromyogram (EMG) response of the cervical muscles to a right lateral impact whiplash-type perturbation when the head is rotated. METHODS: Twenty healthy volunteers were subjected to right lateral impacts of 4.2, 8.1, 10.3, and 12.5 m/s2 and were looking either left or right. Bilateral EMGs of the sternocleidomastoid, trapezius, and splenius capitis muscles were recorded. Triaxial accelerometers recorded the acceleration of the chair, torso at the shoulder level, and head of the participant. RESULTS: In a right lateral impact, muscle responses were of low magnitude with the head rotated to either the left or the right. At the highest acceleration of 12.5 m/s2, all generated less than 39% of their maximal voluntary contraction EMG. The sternocleidomastoid muscle showed a greater EMG response than its counterpart and the muscles contralateral to the direction of impact had higher EMG responses. The time to onset of the EMG for the splenii capitis and trapezii generally decreased with increasing levels of acceleration. As anticipated, an increase in applied acceleration resulted in an increase in accompanying head accelerations (P < .05), and when the head acceleration increased, so too did the force equivalent exertions by the various muscles. CONCLUSIONS: Overall, a right lateral impact with head rotation to either right or left appears to reduce the activity and thus the risk of muscle injury, perhaps because of "bracing" by muscles actively producing rotation or because of greater spinal stability from other structures when the head is in the rotated position.

Cervical muscle response to trunk flexion in whiplash-type lateral impacts.

The purpose of this study was to determine the response of the cervical muscles to increasing low-velocity, whiplash-type lateral impacts when the occupant is seated out of the recommended driving position (neutral posture). Twenty healthy volunteers were subjected to left lateral impacts of 4.1, 7.7, 10.5, and 13.7 m/s(2) acceleration, with their trunk flexed by 45 degrees and laterally flexed to the right and left also by 45 degrees at the time of impact. Bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis were recorded. Under these conditions of trunk-flexed postures, in a left lateral impact, muscle responses were of generally low magnitude with the trunk flexed to either the left or right. Even at the highest acceleration of 13.7 m/s(2), all muscles generated less than 37% of their known maximal voluntary contraction electromyogram. Also, in these left lateral impacts, the right splenius capitis showed a greater EMG response than the left splenius capitis regardless of whether the subject was flexed to the right or left at the time of impact. The right splenius capitis (the one contralateral to the left lateral impact direction) was more active than its counterpart. Compared to what is known for EMG responses with an occupant in the neutral posture, the right sternocleidomastoid (usually the most active muscle in a left lateral collision) was significantly less-active with trunk flexion than with neutral posture conditions (P<0.01). In the absence of bodily impact, the flexed trunk posture does not produce a biomechanical response that would increase the likelihood of cervical muscle injury in low velocity lateral impacts, and may lessen the risk of injury for some muscles.

Analysis of right anterolateral impacts: the effect of head rotation on the cervical muscle whiplash response.

BACKGROUND: The cervical muscles are considered a potential site of whiplash injury, and there are many impact scenarios for whiplash injury. There is a need to understand the cervical muscle response under non-conventional whiplash impact scenarios, including variable head position and impact direction. METHODS: Twenty healthy volunteers underwent right anterolateral impacts of 4.0, 7.6, 10.7, and 13.0 m/s2 peak acceleration, each with the head rotated to the left, then the head rotated to the right in a random order of impact severities. Bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis following impact were measured. RESULTS: At a peak acceleration of 13.0 m/s2, with the head rotated to the right, the right trapezius generated 61% of its maximal voluntary contraction electromyogram (MVC EMG), while all other muscles generated 31% or less of this variable (31% for the left trapezius, 13% for the right spleinus. capitis, and 16% for the left splenius capitis). The sternocleidomastoids muscles also tended to show an asymmetric EMG response, with the left sternocleidomastoid (the one responsible for head rotation to the right) generating a higher percentage (26%) of its MVC EMG than the left sternocleidomastoid (4%) (p < 0.05). When the head is rotated to the left, under these same conditions, the results are reversed even though the impact direction remains right anterolateral. CONCLUSION: The EMG response to a right anterolateral impact is highly dependent on the head position. The sternocleidomastoid responsible for the direction of head rotation and the trapezius ipsilateral to the direction of head rotation generate the most EMG activity.

Kinematic and electromyographic response to whiplash-type impacts. Effects of head rotation and trunk flexion: summary of research.

Despite the fact that whiplash patients often report they had their head rotated or were in a twisted posture at the time of impact, the effect of these postures on the cervical muscle response to impact remains uninvestigated in impact studies. Prior impact studies have positioned the volunteers in the recommended driving position, for example, with head and trunk in a neutral posture. Using an approach of sled impacts with volunteers in very-low velocity impacts to describe the head kinematics and cervical muscle electromyography in response has provided a wealth of data. From this approach, the effect of varying impact direction and level of impact awareness can be discerned without subjecting the volunteers to injury. In part 1 of this review, a further series of results of impacts from eight directions is presented, revealing that the cervical electromyography response to whiplash-type impacts varies according to the presence and direction of head rotation. In part 2, additional data is summarised concerning whiplash-type impacts from 8 directions in the presence of trunk flexion. Contrary to a popular notion, head rotation or trunk flexion at the time of impact are factors that probably reduce injury risk. This data adds to attempts to approach an understanding of the human response to more complex scenarios of low-velocity road collisions.

Effect of trunk flexion on cervical muscle EMG to rear impacts.

OBJECTIVE: To determine the effect of occupant positioning on the response of the cervical muscles to whiplash-type posterolateral impacts. METHODS: Twenty healthy volunteers underwent left posterolateral whiplash-type impacts with the volunteers seated "out-of-position". Electromyograms of the cervical muscles were recorded. RESULTS: Whether having the trunk flexed to the left or right at the time of impact, the muscle responses were low in magnitude, showing a trend to increasing EMG responses with increasing acceleration (P>0.05). The time to onset and time to peak electromyogram for most muscles showed a trend to progressively decrease with increasing levels of acceleration. With the subject flexed to the left, all muscles generated 31% or less of the maximal voluntary contraction electromyogram. With the subject flexed to the right, all muscles generated 27% or less of their maximal electromyogram. In both positions, the trapezii were the most active (P<0.05). Thus, having the trunk flexed out of neutral posture at the time of impact produces a very low magnitude cervical muscle response compared to impacts with the trunk in neutral posture. CONCLUSIONS: In the absence of bodily impact, the flexed trunk posture appears to produce a biomechanical response that would probably decrease the likelihood of cervical muscle injury in low velocity posterolateral impacts.

Effect of trunk flexion on the occupant neck response to anterolateral whiplash impacts.

OBJECTIVE: The purpose of this study was to determine the response of the cervical muscles to increasing low-velocity anterolateral impacts with the volunteer's trunk flexed to the right and left. METHODS: A total of 20 healthy volunteers were subjected to left anterolateral impacts of 4.0, 7.6, 10.7, and 13.4 m/sec and, sequentially, with trunk flexed either left or right. Bilateral electromyograms (EMGs) of the sternocleidomastoids, trapezii, and splenii capitis were recorded. DESIGN: At an acceleration of 13.4 m/sec, with the trunk flexed left, the left trapezius generated 48% of its maximal voluntary contraction EMG, whereas the right trapezius (contralateral to the left anterolateral impact) generated 38% of this variable. All other muscle generated

Looking away from whiplash: effect of head rotation in rear impacts.

STUDY DESIGN: Twenty healthy volunteers in a laboratory were subjected to rear-end impacts 4.4, 7.9, 10.9, and 13.1 m/s acceleration, with head rotation to the right and left. OBJECTIVE: The purpose of this study was to determine the response of the cervical muscles to increasing low-velocity rear impacts when the head is rotated at the time of impact. SUMMARY OF BACKGROUND DATA: A previous study of rear impacts with head in neutral posture suggests that the burden of impact is borne primarily by the sternocleidomastoid muscles bilaterally. To improve automobile designs to prevent whiplash injury, we need to understand the response of the cervical muscles to whiplash-type perturbations in less-than-ideal conditions, such as when the head is rotated to the right and left at the time of rear-end impact. METHODS: Triaxial accelerometers recorded the acceleration of the sled, torso at the shoulder level, and head of the participant, while bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis were also recorded. RESULTS: For participants having a rear-end impact, whether having the head rotated to the left or right at the time of impact, the muscle responses increased with increasing levels of acceleration (P < 0.01). The time to onset and time to peak electromyogram for all muscles progressively decreased with increasing levels of acceleration (P < 0.01). Which muscle responded most to a whiplash-type neck perturbation was determined by the direction of head rotation. With the head rotated to the left, the right sternocleidomastoid generated 88% of the maximal voluntary contraction electromyogram (at least triple the response of other muscles). In comparison, the left sternocleidomastoid, both trapezii, and the splenii capitis generated on average only 10% to 30% of the maximal voluntary contraction electromyogram with head rotated to the left. On the other hand, with the head rotated to the right, the left sternocleidomastoid generated 94% of the maximal voluntary contraction electromyogram (again, at least triple the response of other muscles). CONCLUSIONS: If the head is rotated out of neutral posture at the time of rear impact, the injury risk tends to be greater for the sternocleidomastoid muscle contralateral to the side of rotation. Measures to prevent whiplash injury may have to account for the asymmetric response because many victims of whiplash are expected to be looking to the left or right at the time of collision.

Effect of head rotation in whiplash-type rear impacts.

BACKGROUND CONTEXT: Knowledge is increasing about the electromyographic and kinematic response of the neck muscles to rear impact, and also recent information is available on the effect of a rear impact offset to the left (posterolateral). The effect of head rotation, however, at the time of rear impact is not known. PURPOSE: The purpose of this study was to examine the effects of head rotation to the left and right on the cervical muscle response to increasing low-velocity posterolateral impacts. STUDY DESIGN/SETTING: Twenty healthy volunteers were subjected to rear impacts of 4.7, 8.3, 10.9 and 13.7 m/s2 acceleration, offset by 45 degrees to the subject's left, with head rotation to right and left. METHODS: Bilateral electromyograms of the sternocleidomastoids, trapezii and splenii capitis were recorded. Triaxial accelerometers recorded the acceleration of the sled, torso at the shoulder level, and head of the participant. RESULTS: With the head rotated to the right, at an acceleration of 13.7 m/s2, the left sternocleidomastoid generated 59% and the right sternocleidomastoid 20% of their maximal voluntary contraction (MVC) electromyogram (EMG). Under these conditions, the remaining muscles (both splenii capitis and trapezius) generated 25% or less of their MVC. With the head rotated to the left, at an acceleration of 13.7 m/s2, the right sternocleidomastoid generated 65% and the left sternocleidomastoid only 11% of the MVC EMG. Under these conditions, again the remaining muscles had low EMG activity (27% or less) with the exception of the left trapezius which generated 47% of its MVC. Electromyographic variables were significantly affected by the levels of acceleration (p<.01). The time to onset and time to peak EMG for all muscles progressively decreased with increasing levels of acceleration, for both head rotation conditions. The kinetic variables and the electromyographic variables regressed significantly on the acceleration (p<.01). CONCLUSIONS: Direction of impact is a factor in determining the muscle response to whiplash, but head rotation at the time of impact is also important in this regard. More specifically, when a rear impact is left posterolateral, it results in increased EMG generation mainly in the contralateral sternocleidomastoid, as expected, but head rotation at the same time in this type of impact reduces the EMG response of the cervical muscles. Muscle injury seems less likely under these conditions in low-velocity impacts.

Cervical muscle response to head rotation in whiplash-type left lateral impacts.

STUDY DESIGN: Twenty healthy volunteers were subjected to left lateral impacts, randomly looking either left or right. OBJECTIVES: The purpose of this study is to determine the response of the cervical muscles to lateral impact whiplash-type perturbations when the head is rotated at the time of impact. SUMMARY OF BACKGROUND DATA: A previous study of left lateral impacts with head in neutral posture suggests that the burden of impact is borne primarily by the splenius capitis muscles. In order to improve automobile designs to prevent whiplash injury, we need to understand the response of the cervical muscles to whiplash-type perturbations in less-than-ideal conditions, such as when the head is rotated to the right and at the time of lateral impact. METHODS: Bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis were recorded. Triaxial accelerometers recorded the acceleration of the sled, torso, and head of the participant. RESULTS: For participants experiencing a left lateral impact, whether having the head rotated to the left or right at the time of impact, the muscle responses generally increased with increasing levels of acceleration (P < 0.05). The time of onset and peak electromyograph reading for most muscles progressively decreased with increasing acceleration. Overall, however, muscle responses were of low magnitude with the head rotated to the left or right. The sternocleidomastoid muscle responsible for head rotation (i.e., right sternocleidomastoid muscle when looking left) had a greater electromyograph response than its counterpart (P < 0.05). The contralateral splenius capitis and trapezius had the highest electromyograph responses. The remaining muscles showed similar levels of electromyograph responses, but even at the highest acceleration of 12.8 m/s, all generated less than 45% of their maximal voluntary contraction electromyograph reading. CONCLUSIONS: Compared to a lateral impact with the volunteer's head in the neutral position, a lateral impact with head rotation to either right or left may reduce the muscle response. Further studies are needed to determine whether or not head rotation at the time of lateral impact reduces overall injury risk.

Kinematic and electromyographic response to whiplash loading in low-velocity whiplash impacts--a review.

Whiplash injury is a common injury, with a substantial health and economic burden. For five decades, researchers have been striving to discover the mechanisms of acute whiplash injury to develop methods of prevention through automobile design, and to develop treatment approaches. While earlier experiments with animals, cadavers, and military volunteers have provided some useful insights, it is only in recent years that research has progressed to reveal how neck muscles respond to collisions, particularly how they bear the burden of the forces of collision and how impact direction affects the neck muscle response which may determine the mechanism of injury. Initial volunteer experiments tended to focus on impact velocities (specifically differences in target and bullet vehicle velocities) and head acceleration, but gradually the focus has shifted to understanding the pattern of spinal segment motion and muscle contraction in response to the perturbation. An approach has been devised using sled impacts with healthy volunteers to elucidate in more detail various head kinematics and cervical muscle responses in low-velocity whiplash-type impacts. This approach involves the use of four levels of very-low to low velocity impacts to describe the kinematics of the head and the EMG response of cervical muscles in response to acceleration, but avoids any discernible risk of injury. This allows researchers to determine the cervical muscle response under many different scenarios, including varying direction of impact, awareness of impending impact, and others, without subjecting volunteers to any discernible risk. An initial series of results of impacts from eight directions is presented here, and these reveal that the cervical response to whiplash-type impacts is modified by impact awareness, muscles studied, and direction of impact. This will hopefully improve the understanding of the human response to low-velocity whiplash impacts.

Turning away from whiplash. An EMG study of head rotation in whiplash impact.

OBJECTIVE: To determine the response of the cervical muscles to whiplash-type perturbations through low-velocity frontal impacts when the head is rotated to the right and left. METHODS: Twenty healthy volunteers were subjected to increasing acceleration in low-velocity frontal impacts, randomly with head rotated either left or right. Bilateral EMG of the sternocleidomastoids, trapezii, and splenii capitis and acceleration of the sled, torso, and head were recorded. RESULTS: With either direction of head rotation at the time of impact, the muscle responses increased with increasing levels of acceleration (p < 0.01). The time to onset and peak electromyogram for all muscles progressively decreased with increasing levels of acceleration. With the head rotated to the left, the left trapezius generated 77% of its maximal voluntary contraction (MVC) EMG (more than double the response of other muscles). In comparison, the right trapezius generated only 33% of its MVC. The right sternocleidomastoid (25%) and left splenius muscles (32%), the ones responsible for head rotation to the left, were more active than their counterparts (the left sternocleidomastoid generated only 5% of its MVC EMG and the right splenius 9%). On the other hand, with the head rotated to the right, the right trapezius generated 71% of its MVC EMG, while the left trapezius generated only 30% of this value. Again, the left sternocleidomastoid (27% of its MVC EMG) and right splenius (28% of its MVC EMG), being responsible for head rotation to the right, were more active than their counterparts (the right sternocleidomastoid generated only 4% of its MVC EMG and the left splenius 13%). CONCLUSIONS: Frontal impacts tend to generate the most muscle activity in the ipsilateral trapezius muscle, increasing the risk of their injury.