T P Holsgrove

Spinal muscle activity in simulated rugby union scrummaging is affected by different engagement conditions.

Biomechanical studies of rugby union scrummaging have focused on kinetic and kinematic analyses, while muscle activation strategies employed by front‐row players during scrummaging are still unknown. The aim of the current study was to investigate the activity of spinal muscles during machine and live scrums. Nine male front‐row forwards scrummaged as individuals against a scrum machine under “crouch‐touch‐set” and “crouch‐bind‐set” conditions, and against a two‐player opposition in a simulated live condition. Muscle activities of the sternocleidomastoid, upper trapezius, and erector spinae were measured over the pre‐engagement, engagement, and sustained‐push phases. The “crouch‐bind‐set” condition increased muscle activity of the upper trapezius and sternocleidomastoid before and during the engagement phase in machine scrummaging. During the sustained‐push phase, live scrummaging generated higher activities of the erector spinae than either machine conditions. These results suggest that the pre‐bind, prior to engagement, may effectively prepare the cervical spine by stiffening joints before the impact phase. Additionally, machine scrummaging does not replicate the muscular demands of live scrummaging for the erector spinae, and for this reason, we advise rugby union forwards to ensure scrummaging is practiced in live situations to improve the specificity of their neuromuscular activation strategies in relation to resisting external loads.

The development of a dynamic, six-axis spine simulator

BACKGROUND CONTEXT Although a great deal of research has been completed to characterize the stiffness of spinal specimens, there remains a limited understanding of the spine in 6 df and there is a lack of data from dynamic testing in six axes. PURPOSE This study details the development and validation of a dynamic six-axis spine simulator. STUDY DESIGN Biomechanical study. METHODS A synthetic spinal specimen was used for the purpose of tuning the simulator, completing positional accuracy tests, and measuring frequency response under physiological conditions. The spine simulator was used to complete stiffness matrix tests of an L3-L4 lumbar porcine functional spinal unit. Five testing frequencies were used, ranging from quasistatic (0.00575 Hz) to dynamic (0.5 Hz). Tests were performed without an axial preload and with an axial preload of 500 N. RESULTS The validation tests demonstrated that the simulator is capable of producing accurate positioning under loading at frequencies up to 0.5 Hz using both sine and triangle waveforms. The porcine stiffness matrix tests demonstrated that the stiffness matrix is not symmetrical about the principal stiffness diagonal. It was also shown that while an increase in test frequency generally increased the principal stiffness terms, axial preload had a much greater effect. CONCLUSIONS The spine simulator is capable of characterizing the dynamic biomechanics of the spine in six axes and provides a means to better understand the complex behavior of the spine under physiological conditions.

Cervical spine injuries: A whole-body musculoskeletal model for the analysis of spinal loading

Cervical spine trauma from sport or traffic collisions can have devastating consequences for individuals and a high societal cost. The precise mechanisms of such injuries are still unknown as investigation is hampered by the difficulty in experimentally replicating the conditions under which these injuries occur. We harness the benefits of computer simulation to report on the creation and validation of i) a generic musculoskeletal model (MASI) for the analyses of cervical spine loading in healthy subjects, and ii) a population-specific version of the model (Rugby Model), for investigating cervical spine injury mechanisms during rugby activities. The musculoskeletal models were created in OpenSim, and validated against in vivo data of a healthy subject and a rugby player performing neck and upper limb movements. The novel aspects of the Rugby Model comprise i) population-specific inertial properties and muscle parameters representing rugby forward players, and ii) a custom scapula-clavicular joint that allows the application of multiple external loads. We confirm the utility of the developed generic and population-specific models via verification steps and validation of kinematics, joint moments and neuromuscular activations during rugby scrummaging and neck functional movements, which achieve results comparable with in vivo and in vitro data. The Rugby Model was validated and used for the first time to provide insight into anatomical loading and cervical spine injury mechanisms related to rugby, whilst the MASI introduces a new computational tool to allow investigation of spinal injuries arising from other sporting activities, transport, and ergonomic applications. The models used in this study are freely available at simtk.org and allow to integrate in silico analyses with experimental approaches in injury prevention.

The dynamic, six-axis stiffness matrix testing of porcine spinal specimens

BACKGROUND CONTEXT Complex testing protocols are required to fully understand the biomechanics of the spine. There remains limited data concerning the mechanical properties of spinal specimens under dynamic loading conditions in six axes. PURPOSE To provide new data on the mechanical properties of functional spinal unit (FSU) and isolated disc (ISD) spinal specimens in 6 df. STUDY DESIGN Dynamic, six-axis stiffness matrix testing of porcine lumbar spinal specimens. METHODS The stiffness matrix testing of lumbar porcine FSU (n=6) and ISD (n=6) specimens was completed in a custom six-axis spine simulator using triangle wave cycles at a frequency of 0.1 Hz. Specimens were first tested without an axial preload, then with an axial preload of 500 N, with equilibration times of both 30 and 60 minutes. RESULTS The stiffness matrices were not symmetrical about the principal stiffness terms. The facets increased all the principal stiffness terms with the exception of axial compression-extension. Significant differences were detected in 15 stiffness terms because of the application of an axial preload in the ISD specimens, including an increase in all principal stiffness terms. There were limited differences in stiffness because of equilibration time of 30 and 60 minutes. CONCLUSIONS The assumption of stiffness matrix symmetry used in many previous studies is not valid. The biomechanical testing of spinal specimens should be completed in 6 df, at physiologic loading rates, and incorporate the application of an axial preload. The present study has provided new data on the mechanical properties of spinal specimens and demonstrates that the dynamic stiffness matrix method provides a means to more fully understand the natural spine and quantitatively assess spinal instrumentation.

The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges

Synopsis Chronic neck pain is a common condition and a primary clinical symptom of whiplash and other spinal injuries. Loading-induced neck injuries produce abnormal kinematics between the vertebrae, with the potential to injure facet joints and the afferent fibers that innervate the specific joint tissues, including the capsular ligament. Mechanoreceptive and nociceptive afferents that innervate the facet have their peripheral terminals in the capsule, cell bodies in the dorsal root ganglia, and terminal processes in the spinal cord. As such, biomechanical loading of these afferents can initiate nociceptive signaling in the peripheral and central nervous systems. Their activation depends on the local mechanical environment of the joint and encodes the neural processes that initiate pain and lead to its persistence. This commentary reviews the complex anatomical, biomechanical, and physiological consequences of facet-mediated whiplash injury and pain. The clinical presentation of facet-mediated pain is complex in its sensory and emotional components. Yet, human studies are limited in their ability to elucidate the physiological mechanisms by which abnormal facet loading leads to pain. Over the past decade, however, in vivo models of cervical facet injury that reproduce clinical pain symptoms have been developed and used to define the complicated and multifaceted electrophysiological, inflammatory, and nociceptive signaling cascades that are involved in the pathophysiology of whiplash facet pain. Integrating the whiplash-like mechanics in vivo and in vitro allows transmission of pathophysiological mechanisms across scales, with the hope of informing clinical management. Yet, despite these advances, many challenges remain. This commentary further describes and highlights such challenges. J Orthop Sports Phys Ther 2017;47(7):450-461. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7255.

Non-invasive vibrometry-based diagnostic detection of acetabular cup loosening in Total Hip Replacement (THR)

Total hip replacement is aimed at relieving pain and restoring function. Currently, imaging techniques are primarily used as a clinical diagnosis and follow-up method. However, these are unreliable for detecting early loosening, and this has led to the proposal of novel techniques such as vibrometry. The present study had two aims, namely, the validation of the outcomes of a previous work related to loosening detection, and the provision of a more realistic anatomical representation of the clinical scenario. The acetabular cup loosening conditions (secure, and 1 and 2 mm spherical loosening) considered were simulated using Sawbones composite bones. The excitation signal was introduced in the femoral lateral condyle region using a frequency range of 100-1500 Hz. Both the 1 and 2 mm spherical loosening conditions were successfully distinguished from the secure condition, with a favourable frequency range of 500-1500 Hz. The results of this study represent a key advance on previous research into vibrometric detection of acetabular loosening using geometrically realistic model, and demonstrate the clinical potential of this technique.

Advanced Multi-Axis Spine Testing: Clinical Relevance and Research Recommendations.

Back pain and spinal degeneration affect a large proportion of the general population. The economic burden of spinal degeneration is significant, and the treatment of spinal degeneration represents a large proportion of healthcare costs. However, spinal surgery does not always provide improved clinical outcomes compared to non-surgical alternatives, and modern interventions, such as total disc replacement, may not offer clinically relevant improvements over more established procedures. Although psychological and socioeconomic factors play an important role in the development and response to back pain, the variation in clinical success is also related to the complexity of the spine, and the multi-faceted manner by which spinal degeneration often occurs. The successful surgical treatment of degenerative spinal conditions requires collaboration between surgeons, engineers, and scientists in order to provide a multi-disciplinary approach to managing the complete condition. In this review, we provide relevant background from both the clinical and the basic research perspectives, which is synthesized into several examples and recommendations for consideration in increasing translational research between communities with the goal of providing improved knowledge and care. Current clinical imaging, and multi-axis testing machines, offer great promise for future research by combining invivo kinematics and loading with in-vitro testing in six degrees of freedom to offer more accurate predictions of the performance of new spinal instrumentation. Upon synthesis of the literature, it is recommended that in-vitro tests strive to recreate as many aspects of the in-vivo environment as possible, and that a physiological preload is a critical factor in assessing spinal biomechanics in the laboratory. A greater link between surgical procedures, and the outcomes in all three anatomical planes should be considered in both the in-vivo and in-vitro settings, to provide data relevant to quality of motion, and stability.

The application of physiological loading using a dynamic, multi-axis spine simulator

In-vitro testing protocols used for spine studies should replicate the in-vivo load environment as closely as possible. Unconstrained moments are regularly employed to test spinal specimens in-vitro, but applying such loads dynamically using an active six-axis testing system remains a challenge. The aim of this study was to assess the capability of a custom-developed spine simulator to apply dynamic unconstrained moments with an axial preload. Flexion-extension, lateral bending, and axial rotation were applied to an L5/L6 porcine specimen at 0.1 and 0.3Hz. Non-principal moments and shear forces were minimized using load control. A 500N axial load was applied prior to tests, and held stationary during testing to assess the effect of rotational motion on axial load. Non-principal loads were minimized to within the load cell noise-floor at 0.1Hz, and within two-times the load-cell noise-floor in all but two cases at 0.3Hz. The adoption of position control in axial compression-extension resulted in axial loads with qualitative similarities to in-vivo data. This study successfully applied dynamic, unconstrained moments with a physiological preload using a six-axis control system. Future studies will investigate the application of dynamic load vectors, multi-segment specimens, and assess the effect of injury and degeneration.

Dynamic, six-axis stiffness matrix characteristics of the intact intervertebral disc, and a disc replacement

Thorough pre-testing is critical in assessing the likely in vivo performance of spinal devices prior to clinical use. However, there is a lack of data available concerning the dynamic testing of lumbar (porcine model) total disc replacements in all six axes under preload conditions. The aim of this study was to provide new data comparing porcine lumbar spinal specimen stiffness between the intact state and after the implantation of an unconstrained total disc replacement, in 6 degrees of freedom. The dynamic, stiffness matrix testing of six porcine lumbar isolated disc specimens was completed using triangle waves at a test frequency of 0.1 Hz. An axial preload of 500 N was applied during all testing. Specimens were tested both in the intact condition and after the implantation of the total disc replacement. Sixteen key stiffness terms were identified for the comparison of the intact and total disc replacement specimens, comprising the 6 principal stiffness terms and 10 key off-axis stiffness terms. The total disc replacement specimens were significantly different to the intact specimens in 12 of these key terms including all six principal stiffness terms. The implantation of the total disc replacement resulted in a mean reduction in the principal stiffness terms of 100%, 91%, and 98% in lateral bending, flexion–extension, and axial rotation, respectively. The novel findings of this study have demonstrated that the unconstrained, low-friction total disc replacement does not replicate the stiffness of the intact specimens. It is likely that other low-friction total disc replacements would produce similar results due to stiffness being actively minimised as part of the design of low-friction devices, without the introduction of stiffening elements or mechanisms to more accurately replicate the mechanical properties of the natural intervertebral disc. This study has demonstrated, for the first time, a method for the quantitative comparative mechanical function testing of total disc replacements and provides baseline data for the development of future devices.

In-vitro study of medial strain distribution in the femur during impaction grafting.

Abstract Impaction bone grafting (IBG) is widely used for revision hip surgery to compensate for bone stock loss. It is performed by impacting morsellized allograft into the femoral canal and acetabulum prior to cementing new total hip components. Per- and post-operative femoral fractures and post-operative implant subsidence are major complications in IBG. The aim of this study was to investigate the strain distribution on the medial side of the femur during impaction grafting and the subsequent stability of the stem under uniaxial cyclic loading. The Exeter IBG technique was used in conjunction with Howmedica X-change instrumentation. Sawbones® composite femora were used. An impactometer, which provides a known impaction energy and momentum, was used to standardize the impaction process. Three drop heights, 130, 260, and 390 mm, were used for proximal impaction. In-vitro medial hoop strains and the number of impacts were recorded. A drop height of 260 mm was found to provide sufficient energy for impaction without introducing excessive strains to achieve implant stability. Furthermore, a feasibility study was performed on the use of a proximal impaction cap (PIC) to restrain extrusion of the graft during impaction. Although no significant difference in impaction strains or stem stability in uniaxial cylic loading was found by using a PIC, it is postulated that the design of a proximal impactor could be improved to assist with proximal stem alignment and graft containment.