Moshe Solomonow

Muscular coactivation: The role of the antagonist musculature in maintaining knee stability

The objective of this study was to quantify the coacti vation patterns of the knee flexor and extensor muscles as part of continued efforts to identify the role of the antagonist muscles in maintaining joint stability. The simultaneous EMG from the flexor and extensor muscles of the knee were recorded during maximal effort, slow isokinetic contractions (15 deg/sec) on the plane parallel to the ground to eliminate the effect of gravity. The processed EMG from the antagonist mus cle was normalized with respect to its EMG as agonist at maximal effort for each joint angle. The plots of normalized antagonist EMG versus joint angle for each muscle group were shown to relate inversely to their moment arm variations over the joint range of motion. Additional calculations demonstrated that the antago nist exerts nearly constant opposing torque throughout joint range of motion. Comparison of data recorded from normal healthy subjects with that of high perform ance athletes with hypertrophied quadriceps demon strated strong inhibitory effects on the hamstrings coac tivations. Athletes who routinely exercise their ham strings, however, had a coactivation response similar to that of normal subjects. We concluded that coactivation of the antagonist is necessary to aid the ligaments in maintaining joint stability, equalizing the articular surface pressure dis tribution, and regulating the joints mechanical imped ance. The reduced coactivation pattern of the unexer cised antagonist to a hypertrophied muscle increases the risk of ligamentous damage, as well as demon strates the adaptive properties of the antagonist muscle in response to exercise. It was also concluded that reduced risk of knee injuries in high performance ath letes with muscular imbalance could result from com plementary resistive exercise of the antagonist muscle.

The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability

The synergistic action of the ACL and the thigh muscles in maintaining joint stability was studied experimentally. The EMG from the quadriceps and hamstring muscle groups was recorded and analyzed in three separate experimental procedures in which the knee was stressed. The test revealed that direct stress of the ACL has a moderate inhibitory effect on the quadriceps, but simultaneously it directly excites the hamstrings. Similar responses were also obtained in patients with ACL damage during loaded knee extension with tibia subluxation, indicating that an alternative reflex arc unrelated to ACL receptors was available to maintain joint integrity. The antagonist muscles (hamstrings) were clearly demonstrated to assume the role of joint stabilizers in the patient who has a deficient ACL. The importance of an appropriate muscle-conditioning rehabilitation program in such a patient is substantiated.

The ligamento-muscular stabilizing system of the spine.

Study Design. Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4‐L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles. Objectives. To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento‐muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc. Summary of Background Data. The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co‐contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found. Methods. The supraspinous ligament at L2‐L3 and L3‐L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4‐L5. Electro‐myography was performed from the multifidus muscles at L2‐L3 and L3‐L4, bilaterally. In 12 cats, the supraspinous ligaments from L1‐L2 to L6‐L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion. Results. Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1‐L2 to L6‐L7 motion segments. In the free‐spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligment resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below. Conclusions. Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.

Sensorimotor control of knee stability. A review

Traditionally, the concept of joint stability considered the displacement (or subluxation) of two bones relative to each other as the measurement index, and attributed the preservation of such stability in its physiologic range to the various ligaments associated with the joint. Although the ligaments are indeed the major restraints of any joint, the significant contribution of the musculature toward joint stability had been grossly overlooked or neglected until the last 15 years. The value and importance of muscular activity in that role becomes immediately apparent if one performs even a superficial functional comparison of muscles and ligaments. Ligaments are passive viscoelastic structures, whereas muscles are dynamic viscoelastic organs. The viscoelastic effects of the ligaments are activated and applied strictly upon the geometric and kinematic configuration of the joint traversing through its range of motion according to fixed force‐displacement relationships. The musculature, however, can apply passive viscoelastic effects to the joint when not active (passive tone) and variable dynamic viscoelastic effects when contracting under voluntary or reflexive control, and at any desirable point in the range of motion and in response to joint speed, external load, gravity, pain, and so forth, while executing the functional objective of the movement set by the individual. Preservation of joint stability cannot be ascribed to the ligaments alone, but should be considered as a synergistic function in which bones, joint capsules, ligaments, muscles, tendons, and sensory receptors and their spinal and cortical neural projects and connections function in harmony.

Biomechanics of increased exposure to lumbar injury caused by cyclic loading: Part 1. Loss of reflexive muscular stabilization.

STUDY DESIGN The recording of electromyographic responses from the in vivo lumbar multifidus of the cat, obtained while cyclic loading was applied as in occupational bending/lifting motion over time. OBJECTIVES To determine whether the effectiveness of stabilizing reflexive muscular activity diminishes during prolonged cyclic activity; the recovery of lost muscle activity by a 10-minute rest; and whether such diminished muscular activity is caused by fatigue, neurologic habituation, or desensitization of mechanoreceptors in spinal viscoelastic tissues resulting from its laxity. SUMMARY OF BACKGROUND DATA The literature repeatedly confirms observation that cyclic occupational functions expose workers to a 10-fold increase in episodes of low back injury and pain. The biomechanical evidence indicates that creep in the viscoelastic tissues of the spine causes increased laxity in the intervertebral joints. The impact of cyclic activity on the function of the muscles, which are the major stabilizing structures of the spine, is not known. METHODS Electromyography was performed from the L1 to L7 in vivo multifidus muscles of the cat, while cyclic passive loading of 0.25 Hz was applied to L4-L5. Cyclic loading was applied for 50 minutes, followed by 10 minutes rest and a second 50-minute cyclic loading session. A third 50-minute cyclic loading period also was applied after the preload was reset to 0.5 N to offset the effect of laxity. RESULTS Reflexive muscular activity was recorded from the multifidus muscles of all lumbar levels at the initiation of the first 50 minutes of cyclic loading. Activity recorded on electromyography quickly diminished with each cycle during the first 8 minutes of loading to 15% of its initial value. A slower decrease in muscular activity was evident throughout the remaining period, settling at 5% to 10% of its initial level by the end of 50 minutes. A 10-minute rest provided a 20% to 25% recovery of the electromyographic activity, but that was lost within the first minute of cycling. Offsetting the laxity in the spine resulted in full restoration of the electromyographic activity at all lumbar levels. CONCLUSIONS The creep induced in the viscoelastic tissues of the spine as a result of cyclic loading desensitizes the mechanoreceptors within, which is manifest in dramatically diminished muscular activity, allowing full exposure to instability and injury, even before fatigue of the musculature sets in.Study Design.The recording of electromyographic responses from the in vivo lumbar multifidus of the cat, obtained while cyclic loading was applied as in occupational bending/lifting motion over time.Objectives.To determine whether the effectiveness of stabilizing reflexive muscular activity diminish

Anterior-posterior and rotational displacement of the tibia elicited by quadriceps contraction

The anterior-posterior displacement and rotation of the tibia elicited by isolated loading of the quadriceps mus cle was determined as a function of joint angle and muscle load using a computerized radiographic tech nique. Data collected from 12 fresh-frozen cadaveric knees demonstrated that quadriceps contraction can result in significant (<7 mm) anterior displacement of the tibia in the range of 0° to 80° of flexion, and a mild (<2 mm) posterior displacement in the range of 80° to 120° of flexion. Peak anterior displacement of 6.3 mm was observed at 30° of flexion under a 12 kg load in the quadriceps, while a constant 1.5 mm posterior displacement was observed throughout flexion angles exceeding 80°. It was further shown that the magnitude of the anterior displacement increased nonlinearly as the quadriceps force increased. Loading of the quadri ceps also resulted in internal rotation of the tibia in the range of 0° to 90° of flexion, and in external rotation of the tibia in the range of 90° to 120°. Peak internal rotation of 7° was observed at 15° of flexion and a peak external rotation of 1 ° was detected at 120° of flexion. Larger quadriceps load resulted in larger rota tion. We concluded that quadriceps contraction during knee extension has direct impact on anterior displace ment and rotation of the tibia and therefore on anterior cruciate ligament stress, increasing it as the muscles force is increased during knee extension. It is sug gested that partial quadriceps atrophy in knees with anterior cruciate ligament deficiency may be explained as a protective response. This would bring into question the practice of quadriceps exercise after ligament inju ries and repair, as well as current orthotics concepts.

The effect of joint velocity on the contribution of the antagonist musculature to knee stiffness and laxity

The electromyographic (EMG) coactivation patterns of the knee flexors and extensors when acting as antag onists were studied as a function of limb velocity to assess their contribution to joint stiffness and laxity. Normalized antagonist coactivation patterns devel oped from surface EMG recordings from the hamstrings and quadriceps during maximal effort isokinetic exten sion and flexion, respectively, demonstrated character istic variations as the joint velocity increased from 15 deg/sec up to 240 deg/sec. The two-tailed t-test (P < 0.1) was performed on the data obtained from eight normal knees. The results indicate that both hamstrings and quadriceps demonstrate a significant increase (>100%) in their antagonist coactivation pattern during the final 40° of fast extension and flexion movements, respectively, as limb velocity increases. A minor de crease in antagonist activity of the hamstrings (24%) and quadriceps (8%) was evident during the initial phase of the extension and flexion movements, respec tively, as joint velocity increased. We concluded that as limb velocity is increased, there is a substantial reflexive (unintentional) increase in the contribution of the antagonist musculature to joint stiff ness and reduction of laxity. The results also suggest that strength training of the hamstrings (rather than quadriceps) should be considered as a modality for conservative treatment of ACL deficiencies, as well as an adjunct to surgical reconstruction. Such training can also reduce the risk of high performance athletes in a reflexive manner by increasing joint stiffness.

Flexion–relaxation response to static lumbar flexion in males and females

OBJECTIVE To determine if creep developed in the lumbar viscoelastic tissues during a period of static flexion elicited changes in the muscular responses of the flexion-relaxation phenomenon. BACKGROUND Static lumbar flexion is a risk factor in workers, yet the physiological biomechanical and histological processes active in the evolution of the consequent low back disorder were not demonstrated experimentally. Controlled animal studies show that static lumbar flexion develops creep in the associated viscoelastic tissues and elicits spasms and modification of muscle function. Such neuromuscular changes are to be investigated in this study while assessing normal human subjects via the flexion-relaxation phenomenon. METHODS Male and female subject groups performed three bouts of lumbar flexion-extension before and after a 10 min period of static lumbar flexion. The surface electromyographic from the erector spinae muscles as well as flexion angle were recorded. The angle in which electromyographic diminished during flexion and initiated during extension was determined and subjected to ANOVA with repeated measures to determine any significant changes in the flexion-relaxation response. RESULTS The erector spinae were active through a significantly larger angle during flexion and initiated activity significantly earlier during extension after static flexion. Females demonstrated more pronounced changes than males. EMG amplitude did not change significantly. Spasms were recorded in more than half of the subjects during the static flexion period. CONCLUSIONS Creep developed during a short static lumbar flexion elicited significant changes in the muscular activity pattern of the flexion-relaxation phenomenon. The muscles seem to compensate for the loss of tension in the lumbar viscoelastic tissues, while spasms suggest that some micro-damage was incurred to the viscoelastic tissues. RELEVANCE Static lumbar flexion is shown experimentally as an activity that constitutes an occupational risk factor for the development of low back disorder.

Surface and wire EMG crosstalk in neighbouring muscles

Surface and wire myoelectric activity of the medial gastrocnemius (MG), lateral gastrocnemius (LG) and tibialis anterior (TA) of the cat were recorded during supramaximal stimulation applied via their nerves before and after the muscle nerve to the LG and TA were cut in order to determine the amount of EMG crosstalk amongst neighbouring muscles. It was shown that the peak-to-peak (p-p) amplitude and mean absolute value (MAV) of crosstalk M waves recorded from the LG and TA after their nerve was cut did not exceed 5% of their maximal value for surface electrodes and 2.5% of their maximal value for wire electrodes. EMG crosstalk values were similar in terms of peak to peak and MAV. Surface EMG crosstalk values were significantly higher in preparations in which a substantial amount of subcutaneous fat covered the muscles, being 20 (± 16.6) % MAV and 16 (± 12) % p-p. During increasing force contraction (accomplished by orderly recruitment of motor units) from 10-100% of the maximal force of the MG the corresponding crosstalk in the LG and TA increased linearly with the EMG of the MG. It is concluded that the crosstalk problem in surface recording is negligible for most biomechanical studies in which standard EMG recording protocol is employed, yet a warning is issued against the indiscriminate recording of surface EMG from muscles covered by adipose tissue.

Muscular dysfunction elicited by creep of lumbar viscoelastic tissue

The biomechanics, histology and electromyography of the lumbar viscoelastic tissues and multifidus muscles of the in vivo feline were investigated during 20 min of static as well as cyclic flexion under load control and during 7 h of rest following the flexion. It was shown that the creep developed in the viscoelastic tissues during the 20 min of static or cyclic flexion did not fully recover over the 7 h of following rest. It was further seen that a neuromuscular disorder with five distinct components developed during and after the static and cyclic flexion. The neuromuscular disorder consisted of a decreasing magnitude of reflexive EMG from the multifidus upon flexion as well as of superimposed spasms. The recovery period was characterized by an initial muscle hyperexcitability, a slowly increasing reflexive EMG and a delayed hyperexcitability. Histological data from the supraspinous ligament demonstrate significant increase (x 10) in neutrophil density in the ligament 2 h into the recovery and even larger increase (x 100) 6 h into the recovery from the 20 min flexion, indicating an acute soft tissue inflammation. It was concluded that sustained static or cyclic loading of lumbar viscoelastic tissues may cause micro-damage in the collagen structure, which in turn reflexively elicit spasms in the multifidus as well as hyperexcitability early in the recovery when the majority of the creep recovers. The micro-damage, however, results in the time dependent development of inflammation. In all cases, the spasms, initial and delayed hyperexcitabilities represent increased muscular forces applied across the intervertebral joints in an attempt to limit the range of motion and unload the viscoelastic tissues in order to prevent further damage and to promote healing. It is suggested that a significant insight is gained as to the development and implications of a common idiopathic low back disorder as well as to the development of cumulative trauma disorders.