Geneviève A. Dumas

Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences

This study sought to investigate the normal muscle fibre size and type distribution of the human erector spinae, both in thoracic and lumbar regions, in a group of 31 young healthy male (n=17) and female (n=14) volunteers. Two percutaneous muscle biopsy samples were obtained under local anaesthesia, from the belly of the left erector spinae, at the levels of the 10th thoracic and 3rd lumbar vertebrae. Samples were prepared for routine histochemistry for the identification of fibre types. Fibre size (cross‐sectional area (CSA) and narrow diameter (ND)) was quantified using computerised image analysis. The mean CSA/ND for each fibre type was greater in the thoracic than the lumbar region, but there was no difference between the 2 regions either for percentage type I (i.e. percentage distribution by number), percentage type I area (i.e. relative area of the muscle occupied by type I fibres) or the ratio describing the size of the type I fibre relative to that of the type II. Men had larger fibres than women, for each fibre type and at both sampling sites. In the men, each fibre type was of a similar mean size, whereas in the women the type I fibres were considerably larger than both the type II A and type II B fibres, with no difference between the latter two. In both regions of the erector spinae there was no difference between men and women for the proportion (%) of a given fibre type, but the percentage type I fibre area was significantly higher in the women.

The influence of muscle fiber size and type distribution on electromyographic measures of back muscle fatigability.

Study Design. This was a cross‐sectional study carried out on a group of 31 healthy, consenting volunteers with no history of low back pain (17 men, 14 women). Objectives. To evaluate the relationship between electromyographic measures of erector spinae fatigability and the muscles fiber type characteristics. Summary of Background Data. Using electromyographic techniques, a pronounced fatigability of the muscles of patients with low back pain has been identified. It has been postulated that this is the result of an unfavorable back muscle fiber type distribution, although an association between electromyographic measures of fatigue and the muscles fiber type characteristics has never been established. Methods. Two tests of back extensor fatigability were performed (on separate days), each to the limit of endurance: 1) maintenance of 60% total maximum voluntary contraction of the back extensors, and 2) performance of the Biering‐Sørensen test. Pairs of surface electrodes were attached to the skin overlying the belly of the erector spinae, bilaterally, at T10 and L3. The median frequency was computed from the electromyographic power spectrum, and fatigability was given by the slope of the linear regression of median frequency on time (MFgrad; %.s−1). One week later, two percutaneous erector spinae muscle biopsy samples were obtained from the same sites described for electromyography (left side only). Samples were prepared for histochemistry for the identification of muscle fiber types. Fiber sizes (cross‐sectional areas) were quantified using computerized image analysis. Results. The mean fiber size at each erector spinae region showed a significant correlation with maximum back extensor strength. In the thoracic region, the relative area of the muscle occupied by Type I fibers (which accounts for the relative size and distribution of the fiber types) showed a significant relationship with MFgrad recorded during each fatigue test. A similar relationship was observed for the lumbar region, but for the Biering‐Sørensen test only. Conclusions. The electromyographic changes recorded in back muscles during fatigue appear to be related to the underlying muscle fiber type area distribution. This confirms the usefulness of electromyography in reflecting such muscle characteristics in a noninvasive manner, when monitoring changes in function consequent to the development of, or rehabilitation from, low back pain.

Exercise, posture, and back pain during pregnancy

In this article the effect of exercise on pregnancy-related back pain is reported. Sixty five pregnant volunteers were included in the study, of whom 27 were enrolled in exercise classes designed according to Canadian guidelines, and 38 acted as sedentary controls. Back pain and functional limitations were assessed every 4 weeks during pregnancy and 4 months postpartum by questionnaires. No significant differences in back pain or functional limitations reported by the two groups were found. The biomechanical factors measured in this study, weight, back posture, and laxity, were unable to explain most of the variation in pain reported. RELEVANCE: This study showed that fitness classes for pregnant women designed according to Canadian guidelines had no detectable effect on back pain during pregnancy. If prevention of pregnancy-related back pain is sought through exercise, design of fitness programmes for pregnant women should be reconsidered.

Calibration of position and angular data from a magnetic tracking device.

This paper describes a method for calibrating data from a magnetic tracking device. Position and orientation data were collected in a 1. 6x0.8x1.4m(3) volume using a Polhemus Fastrak((R)) in conjunction with both a long-range and standard transmitter. Position and orientation data were calibrated using a locally linear model based on the position of the measurement. After calibration, the average position and angular errors were less than 1.8cm and 1.2 degrees up to 1.8m from the transmitter for the long-range transmitter. For the standard transmitter, even after calibration, errors increased sharply when the sensor was more than 1.2m from the transmitter. Up to that distance, post-calibration errors were less than 1.2cm and 1. 2 degrees, while up to 1.8m they were below 5cm and 4 degrees. These errors could be further reduced by noise filtering. However, use of the standard transmitter is not recommended at distance greater than 1.2m due to orientation-based effects. It was concluded that for the volume investigated, tracking devices could provide similar three-dimensional accuracy to video systems.

A Longitudinal Study of the Development of Low Back Pain in an Industrial Population

Study Design. This is a longitudinal study in which industrial workers without chronic low back pain (LBP) were initially assessed with a comprehensive test battery and surveyed every 6 months thereafter for 2 years. Objective. To determine factors that may predispose industrial workers who lift over 5000 kg per shift to LBP. Summary of Background Data. Prospective studies are small in number and often limited in breadth or depth of the test battery, methodologic issues, or investigator expertise. There are no prospective studies that focus on a homogeneous work sample of industrial employees. Methods. Production workers (n = 149) who volunteered for the 2-year study were assessed using physical measures (e.g., muscular strength, endurance, and flexibility), lifting kinematics (a sagittal plane box lift), and health, lifestyle, and work environment data (paper questionnaires). Follow-up questionnaires were distributed every 6 months for 2 years. Results. Using self-report of LBP as the main outcome measure, eight variables predicted LBP in this sample with a 75% correct prediction rate. Predictor variables included age, thoracic acceleration during the trunk velocity test, median frequency intercept of electromyography of the right L3 erector spinae, quadriceps strength, quadriceps endurance, self-assessment of fitness, having a confidante, and number of medications currently taken. Conclusion. Results confirmed the multifactorial nature of low back pain and suggest that personal fitness is an important defense against low back pain, even in manual handling lifting tasks.

A minimally disruptive technique for measuring intervertebral disc pressure in vitro: application to the cervical spine.

A novel technique to measure in vitro disc pressures in human cervical spine specimens was developed. A miniature pressure transducer was used and an insertion technique was designed to minimise artefacts due to insertion. The technique was used to measure the intradiscal pressure in cervical spines loaded in pure axial compression. The resulting pressure varied linearly with the applied compressive force with coefficients of determination (r(2)) greater than 0.99 for each of the four specimens. Peak pressures between 2.4 and 3.5MPa were recorded under 800N of compression.

Exercise, posture, and back pain during pregnancy: Part 2. Exercise and back pain

One of the expected benefits of exercise programmes for pregnant women is to reduce or prevent back pain by improving posture. The aim of this project was to evaluate the effect of fitness classes for pregnant women on posture and back pain. In this article, postural aspects are reported. Sixty five pregnant volunteers were included in the study, of whom 27 were enrolled in exercise classes designed according to Canadian guidelines and 38 acted as sedentary controls. Posture was assessed every 4 weeks during pregnancy and 4 months postpartum by measuring curvatures of the lumbar and thoracic spines in a standard relaxed standing position from lateral photographs. Laxity of knee ligaments was also monitored using a clinical arthrometer. Weight gain could explain part of lordosis increase during pregnancy but the effect was not very strong. No effect of exercise on posture was detected. RELEVANCE: This study showed that fitness classes for pregnant women designed according to Canadian guidelines had no detectable effect on posture during pregnancy.

Postural changes associated with pregnancy and their relationship with low-back pain

This longitudinal study examined the postural changes that occur during pregnancy and their association with low-back pain. The lordotic curvature, kyphotic curvature and position of the line of gravity were measured. The degree of low-back pain was assessed using a daily pain diary. Each measurement was recorded in 30 healthy pregnant women on a monthly basis until term and once post partum. The results reveal many different postural behaviours, but the majority of women experienced a flattening of the lumbar spine during pregnancy. The changes in kyphotic curvature were not so well defined. In the majority of women the position of the line of gravity was unaffected during pregnancy. Most women experienced some degree of low-back pain but in most cases it was mild. Although Pearson product-moment correlations revealed few significant correlations, the most interesting finding was that in the early stages of pregnancy, the changes in lordosis and lowback pain were inversely related.

A continuous pure moment loading apparatus for biomechanical testing of multi-segment spine specimens

An apparatus is described that enables the application of continuous pure moment loads to multi-segment spine specimens. This loading apparatus allows continuous cycling of the spine between specified flexion and extension (or right and left lateral bending) maximum load endpoints. Using a six-degree-of-freedom load cell and three-dimensional optoelectronic stereophotogrammetry, characteristic displacement versus load hysteresis curves can be generated and analyzed for different spinal constructs of interest. Unlike quasi-static loading, the use of continuous loading permits the analysis of the spines behaviour within the neutral zone. This information is of particular clinical significance given that the instability of a spinal segment is related to its flexibility within the neutral zone. Representative curves for the porcine lumbar spine in flexion-extension and lateral bending are presented to illustrate the capabilities of this system.

Evaluation and calibration of an electromagnetic tracking device for biomechanical analysis of lifting tasks.

Electromagnetic motion tracking devices are increasingly used as a kinematic measuring tool. The aim of this study was to evaluate a long-range transmitter in an environment with a conventional force plate present in order to assess its suitability for further biomechanical applications. Using a calibration apparatus developed in our lab and Optotrack measurements, the performances of the Motion Star were evaluated. Positions and orientations were measured in a 140 x 80 x 120 cm(3) space centered on the force plate. Using a mathematical model developed at Queens University, these data were calibrated. Errors on position and orientation were less than 150 mm and 10 degrees before calibration of the Motion Star, and less than 20mm and 2 degrees after calibration, with no differences between data collected with the force plate switched on/off. These errors did not depend on sensor orientation. Variability of the signal was small indicating minimal noise. Field distortion was the largest source of measurement error, which increased with the distance between the transmitter and the sensor and the proximity of the sensor to the force plate. Before its use for biomechanical analysis of lifting tasks and validation of dynamic models using force plate data, the data from electromagnetic motion tracking devices must be calibrated to decrease the errors due to electromagnetic field distortion.