Idsart Kingma

Validation of a full body 3-D dynamic linked segment model

Abstract In studies related to human movement, linked segment models (LSMs) are often used to quantify forces and torques, generated in body joints. Some LSMs represent only a few body segments. Others, for instance used in studies on the control of whole body movements, include all body segments. As a consequence of the complexity of 3-dimensional (3-D) analyses, most LSMs are restricted to one plane of motion. However, in asymmetric movements this may result in a loss of relevant information. The aim of the current study was to develop and validate a 3-D LSM including all body segments. Braces with markers, attached to all body segments, were used to record the body movements. The validation of the model was accomplished by comparing the measured with the estimated ground reaction force and by comparing the torques at the lumbo-sacral joint that resulted from a bottom-up and a top-down mechanical analysis. For both comparisons, reasonable to good agreement was found. Sources of error that could not be analysed this way, were subjected to an additional sensitivity analysis. It was concluded that the internal validity of the current model is quite satisfactory.

Validation of a dynamic linked segment model to calculate joint moments in lifting.

A two-dimensional dynamic linked segment model was constructed and applied to a lifting activity. Reactive forces and moments were calculated by an instantaneous approach involving the application of Newtonian mechanics to individual adjacent rigid segments in succession. The analysis started once at the feet and once at a hands/load segment. The model was validated by comparing predicted external forces and moments at the feet or at a hands/load segment to actual values, which were simultaneously measured (ground reaction force at the feet) or assumed to be zero (external moments at feet and hands/load and external forces, beside gravitation, at hands/load). In addition, results of both procedures, in terms of joint moments, including the moment at the intervertebral disc between the fifth lumbar and first sacral vertebra (L5-S1), were compared. A correlation of r = 0.88 between calculated and measured vertical ground reaction forces was found. The calculated external forces and moments at the hands showed only minor deviations from the expected zero level. The moments at L5-S1, calculated starting from feet compared to starting from hands/load, yielded a coefficient of correlation of r = 0.99. However, moments calculated from hands/load were 3.6% (averaged values) and 10.9% (peak values) higher. This difference is assumed to be due mainly to erroneous estimations of the positions of centres of gravity and joint rotation centres. The estimation of the location of L5-S1 rotation axis can affect the results significantly. Despite the numerous studies estimating the load on the low back during lifting on the basis of linked segment models, only a few attempts to validate these models have been made. This study is concerned with the validity of the presented linked segment model. The results support the models validity. Effects of several sources of error threatening the validity are discussed.

Mechanical loading of the low back and shoulders during pushing and pulling activities

The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the initial and sustained exerted forces and the mechanical load on the low back and shoulders. Detailed biomechanical models of the low back and shoulder joint were used to estimate mechanical loading. Using generalized estimating equations (GEE) the effects were quantified for exerted push/pull forces, net moments at the low back and shoulders, compressive and shear forces at the low back, and compressive forces at the glenohumeral joint. The results of this study appeared to be useful to estimate ergonomics consequences of interventions in the working constraints during pushing and pulling. Cart weight as well as handle height had a considerable effect on the mechanical load and it is recommended to maintain low cart weights and to push or pull at shoulder height. Initial and sustained exerted forces were not highly correlated with the mechanical load at the low back and shoulders within the studied range of the exerted forces.

Segment inertial parameter evaluation in two anthropometric models by application of a dynamic linked segment model

The estimation of segment inertial parameters (SIPs) is an important source of error in inverse dynamic analysis. In most individual cases SIPs are derived from extrapolation of known SIPs of a certain population through regression equations (proportional models). Another well-known method is the use of mathematical approximation of the shape of human body segments combined with estimations of segment densities (geometric models). In the current study five males and five females performed four different lifting movements in the sagittal plane. A full body linked segment model was applied twice to the same data set, once using a proportional and once using a geometric anthropometric model. As a full body linked segment model is an overdetermined system of equations, four equations could be formed to test the summed effect of SIP errors on the inverse dynamic analysis. The overall performance in terms of coefficients of correlation was better for the geometric model as compared to the proportional model. When a back lifting movement was performed, the equations indicated systematic errors in the proportional model. However, when a leg lifting movement was performed, the equations indicated systematic errors in the geometric model. Therefore, analyzing only one kind of movement does not suffice to draw conclusions with respect to the reliability of an anthropometric model.

Evidence for a role of antagonistic cocontraction in controlling trunk stiffness during lifting

Activity of the abdominal muscles during symmetric lifting has been a consistent finding in many studies. It has been hypothesized that this antagonistic coactivation increases trunk stiffness to provide stability to the spine. To test this, we investigated whether abdominal activity in lifting is increased in response to destabilizing conditions. Ten healthy male subjects lifted 35 l containers containing 15 l of water (unstable condition), or ice (stable condition). 3D-kinematics, ground reaction forces, and EMG of selected trunk muscles were recorded. Euler angles of the thorax relative to the pelvis were determined. Inverse dynamics was used to calculate moments about L5S1. Averaged normalized abdominal EMG activity was calculated to express coactivation and an EMG-driven trunk muscle model was used to estimate the flexor moment produced by these muscles and to estimate the L5S1 compression force. Abdominal coactivation was significantly higher when lifting the unstable load. This coincided with significant increases in estimated moments produced by the antagonist muscles and in estimated compression forces on the L5S1 disc, except at the instant of the peak moment about L5S1. The lifting style was not affected by load instability as evidenced by the absence of effects on moments about L5S1 and angles of the thorax relative to the pelvis. The data support the interpretation of abdominal cocontraction during lifting as subserving spinal stability. An alternative function of the increased trunk stiffness due to cocontraction might be to achieve more precise control over the trajectory of lifted weight in order to avoid sloshing of the water mass in the box and the consequent perturbations.

Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities

Abstract Sagittal balance of the spine is becoming an important issue in the assessment of the degree of spinal deformity. On a standing lateral full-length radiograph of the spine, the plumb line, or sagittal vertical axis (SVA), can be used to determine the spinal sagittal balance. In this procedure patients have to adopt a habitual standing position with the knees extended during radiographic examination, though it is not known whether small changes in the position of the lower extremities affects the location of the SVA. The purpose of the present study was to investigate the effect of postural change on shifts of the SVA, and to evaluate whether the SVA as measured on a standing full-length lateral radiograph can be used as an accurate measurement of spinal balance in clinical practice. Sagittal balance was analyzed using a patient with ankylosis of the entire spine due to ankylosing spondylitis, to eliminate segmental movement of the spine. A virtual SVA was constructed for seven different standing postures by cross-referring the coordinate systems from a standing full-length lateral radiograph of the spine with video analysis. The horizontal distance between the SVA and the anterior superior corner of the sacrum was measured for each posture. Small changes in the joint angles of the lower extremities affected the SVA significantly, and resulted in the horizontal distance between the SVA and the anterior superior corner of the sacrum varying from –4.5 to +14.9 cm. High correlations were found between this distance and the joint angle of the hip (r = –0.959), knee (r = –0.936), and ankle (r = 0.755) (P < 0.01). The results of the study showed that SVA translations during standing radiographic analysis in a patient with a fixed spine depend on small changes in the hip, knee, and ankle joints. Thus, sagittal spinal (im)balance in ankylosing spondylitis can not be measured from the SVA on a standing lateral full-length radiograph of the spine unless strict procedures are developed to control for the angle of the hip, knee, and ankle joints. The accuracy of the SVA as a measurement of sagittal spinal balance in other spinal deformities, with possible additional segmental movements, therefore remains questionable.

Force direction and physical load in dynamic pushing and pulling

In pushing and pulling wheeled carts, the direction of force exertion may, beside the force magnitude, considerably affect musculoskeletal loading. This paper describes how force direction changes as handle height and force level change, and the effects this has on the loads on the shoulder and low back. Eight subjects pushed against or pulled on a stationary bar or movable cart at various handle heights and horizontal force levels while walking on a treadmill. The forces at the hands in the vertical and horizontal direction were measured by a forcetransducer. The forces, body movements and anthropometric data were used to calculate the net joint torques in the sagittal plane in the shoulder and the lumbosacral joint. The magnitudes and directions of forces did not differ between the cart and the bar pushing and pulling. Force direction was affected by the horizontal force level and handle height. As handle height and horizontal force level increased, the pushing force direction changed from 45° (SD 3.3°) downward to near horizontal, while the pulling force direction changed from pulling upward by 14° (SD 15.3°) to near horizontal. As a result, it was found that across conditions the changes in force exertion were frequently reflected in changes in shoulder torque and low back torque although of a much smaller magnitude. Therefore, an accurate evaluation of musculoskeletal loads in pushing and pulling requires, besides a knowledge of the force magnitude, knowledge of the direction of force exertion with respect to the body.

Effects of antagonistic co-contraction on differences between electromyography based and optimization based estimates of spinal forces

Estimates of spinal forces are quite sensitive to model assumptions, especially regarding antagonistic co-contraction. Optimization based models predict co-contraction to be absent, while electromyography (EMG) based models take co-contraction into account, but usually assume equal activation of deep and superficial parts of a muscle. The aim of the present study was to compare EMG based and optimization based estimates of spinal forces in a wide range of work tasks. Data obtained from ten subjects performing a total of 28 tasks were analysed with an EMG driven model and three optimization models, which were specifically designed to test the effects of the above assumptions. Estimates of peak spinal forces obtained using the different modelling approaches were similar for total muscle force and its compression component (on average EMG based predictions were 5% higher) and were closely related (R > 0.92), while differences in predictions of the peak shear component of muscle force were more substantial (with up to 39% lower estimates in optimization based models, R > 0.79). The results show that neither neglecting antagonistic co-contraction, nor assuming equal activation of deep and superficial muscles, has a major effect on estimates of spinal forces. The disparity between shear force predictions was due to an overestimation of activity of the lateral part of the internal oblique muscle by the optimization models, which is explained by the cost function preferentially recruiting larger muscles. This suggests that a penalty for active muscle mass should be included in the cost function used for predicting trunk muscle recruitment.

Foot positioning instruction, initial vertical load position and lifting technique: effects on low back loading

This study investigated the effects of initial load height and foot placement instruction in four lifting techniques: free, stoop (bending the back), squat (bending the knees) and a modified squat technique (bending the knees and rotating them outward). A 2D dynamic linked segment model was combined with an EMG assisted trunk muscle model to quantify kinematics and low back loading in 10 subjects performing 19 different lifting movements, using 10.5 kg boxes without handles. When lifting from a 0.05 m height with the feet behind the box, squat lifting resulted in 19.9% (SD 8.7%) higher net moments (p < 0.001) and 17.0% (SD 13.2%) higher compression forces (p < 0.01) than stoop lifting. This effect was reduced to 12.8% (SD 10.7%) for moments and a non-significant 7.4% (SD 16.0%) for compression forces when lifting with the feet beside the box and it disappeared when lifting from 0.5 m height. Differences between squat and stoop lifts, as well as the interaction with lifting height, could to a large extent be explained by changes in the horizontal L5/S1 intervertebral joint position relative to the load, the upper body acceleration, and lumbar flexion. Rotating the knees outward during squat lifts resulted in moments and compression forces that were smaller than in squat lifting but larger than in stoop lifting. Shear forces were small ( < 300 N) at the L4/L5 joint and substantial (1100 – 1400 N) but unaffected by lifting technique at the L5/S1 joint. The present results show that the effects of lifting technique on low back loading depend on the task context.

Cumulative Low Back Load at Work as a Risk Factor of Low Back Pain: A Prospective Cohort Study

Purpose Much research has been performed on physical exposures during work (e.g. lifting, trunk flexion or body vibrations) as risk factors for low back pain (LBP), however results are inconsistent. Information on the effect of doses (e.g. spinal force or low back moments) on LBP may be more reliable but is lacking yet. The aim of the present study was to investigate the prospective relationship of cumulative low back loads (CLBL) with LBP and to compare the association of this mechanical load measure to exposure measures used previously. Methods The current study was part of the Study on Musculoskeletal disorders, Absenteeism and Health (SMASH) study in which 1,745 workers completed questionnaires. Physical load at the workplace was assessed by video-observations and force measurements. These measures were used to calculate CLBL. Furthermore, a 3-year follow-up was conducted to assess the occurrence of LBP. Logistic regressions were performed to assess associations of CLBL and physical risk factors established earlier (i.e. lifting and working in a flexed posture) with LBP. Furthermore, CLBL and the risk factors combined were assessed as predictors in logistic regression analyses to assess the association with LBP. Results Results showed that CLBL is a significant risk factor for LBP (OR: 2.06 (1.32–3.20)). Furthermore, CLBL had a more consistent association with LBP than two of the three risk factors reported earlier. Conclusions From these results it can be concluded that CLBL is a risk factor for the occurrence of LBP, having a more consistent association with LBP compared to most risk factors reported earlier.