Tyson A.C. Beach

Using the Functional Movement Screen™ to evaluate the effectiveness of training.

Abstract Frost, DM, Beach, TAC, Callaghan, JP, and McGill, SM. Using the functional movement screen™ to evaluate the effectiveness of training. J Strength Cond Res 26(6): 1620–1630, 2012—The Functional Movement Screen™ (FMS) has demonstrated some efficacy in the prediction of injuries and is thus used by many practitioners to make recommendations for exercise. However, questions remain regarding its utility as a means to evaluate the effectiveness of training. Sixty firefighters volunteered to participate, and their FMS scores were examined before and after 12 weeks of training. Individuals were graded on how they chose to perform rather than how they could perform. The participants were assigned to 1 of 3 groups: intervention 1, intervention 2, or control. The 2 intervention groups received three 1.5-hour training sessions each week and differed in the emphasis that was placed on movement quality. Sagittal and frontal plane videos were used to grade the FMS with 3 methods: the standard 0–3 scale, a 100-point scale that weighted specific compensations (research standard), and a modified 100-point scale whereby grades were assigned based on the total number of compensations present. There were no significant differences in the total FMS scores for any group posttraining. However, the scores of 85% of the firefighters who did not receive training did change. The 100-point scale methods resulted in more FMS score changes posttraining, but the between-group interactions were identical to those found with the standard scoring method. The control groups scores were not consistent pretraining and posttraining; thus, the influence of each intervention could not be evaluated. Currently, the FMS might provide a momentary impression of general movement quality, although further efforts would likely assist in the development of better ways to implement the test, interpret the results, and generate reliable scores.

Muscular contribution to low-back loading and stiffness during standard and suspended push-ups.

Push-up exercises are normally performed to challenge muscles that span upper extremity joints. However, it is also recognized that push-ups provide an effective abdominal muscle challenge, especially when the hands are in contact with a labile support surface. The purpose of this study was to compare trunk muscle activation levels and resultant intervertebral joint (IVJ) loading when standard and suspended push-ups were performed, and to quantify and compare the contribution of trunk muscles to IVJ rotational stiffness in both exercises. Eleven recreationally trained male volunteers performed sets of standard and suspended push-ups. Upper body kinematic, kinetic, and EMG data were collected and input into a 3D biomechanical model of the lumbar torso to quantify lumbar IVJ loading and the contributions of trunk muscles to IVJ rotational stiffness. When performing suspended push-ups, muscles of the abdominal wall and the latissimus dorsi were activated to levels that were significantly greater than those elicited when performing standard push-ups (p<.05). As a direct result of these increased activation levels, model-predicted muscle forces increased and consequently led to significantly greater mean (p=.0008) and peak (p=.0012) lumbar IVJ compressive forces when performing suspended push-ups. Also directly resulting from the increased activation levels of the abdominal muscles and the latissimus dorsi during suspended push-ups was increased muscular contribution to lumbar IVJ rotational stiffness (p<.05). In comparison to the standard version of the exercise, suspended push-ups appear to provide a superior abdominal muscle challenge. However, for individuals unable to tolerate high lumbar IVJ compressive loads, potential benefits gained by incorporating suspended push-ups into their resistance training regimen may be outweighed by the risk of overloading low-back tissues.

Physical fitness improvements and occupational low-back loading - an exercise intervention study with firefighters.

The impact of exercise on firefighter job performance and cardiorespiratory fitness has been studied extensively, but its effect on musculoskeletal loading remains unknown. The aim of this study was to contrast the physical fitness and low-back loading outcomes of two groups of firefighters who completed different exercise programmes. Before and after 12 weeks of exercise, subjects performed a physical fitness test battery, the Functional Movement Screen™ (FMS) and simulated job tasks during which peak L4/L5 joint compression and reaction shear forces were quantified using a dynamic biomechanical model. Subjects who exercised exhibited statistically significant improvements (p < 0.05) in body composition, cardiorespiratory fitness, muscular strength, power, endurance and flexibility, but FMS scores and occupational low-back loading measures were not consistently affected. Firefighters who are physically fit are better able to perform essential job duties and avoid cardiac events, but short-term improvements in physical fitness may not necessarily translate into reduced low-back injury risk. Practitioner Summary: Firefighters must be physically fit to safely and effectively meet the demands of their work, but improvements in physical fitness alone may not necessarily reduce their low-back injury risk.

Does prolonged seated deskwork alter the lumbar flexion relaxation phenomenon

Sustained maximum lumbar spine flexion can increase the angle at which the low back flexion relaxation phenomenon (FRP) is observed. This adaptation has been hypothesized to have implications for the control of lumbar spine stability and increase the potential for low back injury. The objective of this study was to investigate if similar changes in the FRP would occur from sub-maximal spine flexion induced by an extended continuous duration of seated office deskwork. Twenty-three participants (12 male and 11 female) performed three bouts of full forward spine flexion interspersed with two 1-h periods of seated deskwork. Lumbar spine angular kinematics and electromyographic activity from the lumbar erector spinae were obtained throughout all trials. The angles at which myoelectric silence occurred (FRP onset) were documented. Lumbar flexion at FRP onset increased by 1.3±1.5° after 1-h of sitting (p<0.05) with no further increase after 2-h. However, when the angle at the FRP onset was normalized to the total range of flexion, there was no difference in the FRP onset. These results suggest that the seated posture may induce residual deformation in the viscoelastic passive tissues of the low back; this could increase the challenge of controlling spine motion and reduce the load-bearing capacity of the lumbar spine system during activities performed following extended bouts of sitting.

Using sitting as a component of job rotation strategies: are lifting/lowering kinetics and kinematics altered following prolonged sitting.

Workers are often required to perform manual materials handling tasks immediately following periods of prolonged sitting either as a secondary job component of as different tasks in a job rotation strategy. The goal of this investigation was to determine if changes to low-back kinetics and/or kinematics occurred during repetitive lifting/lowering exertions following extended seated exposures. Upper body kinematics, lumbar spine flexion angle, pelvic orientation and bilateral muscle activity from the external abdominal obliques and lumbar erector spinae were recorded for 8 males and 8 females while they alternated between sessions of repetitive lifting/lowering and prolonged sitting. Upper body kinematics were used as inputs to a linked segment model to compute low-back flexion/extension moments, compression, and shear. Peak lumbar flexion was reduced by 1.8 degrees during the lifting/lowering exertions following the first hour of sitting which consequently led to a reduction of approximately 50N in the reaction anteroposterior shear forces. Sitting postures were consistent with previously reported data. The reduced shear loads during repetitive lift/lower exertions following prolonged sitting may be a consequence of alterations in passive tissue properties which could alter the risk of low-back injury, although future research is required to examine the biomechanical significance of this finding. Changes to both kinematics and kinetics were minimal suggesting that using prolonged sitting as a component of a task series in job rotation does not alter the risk present when combined with repetitive lifting tasks.

Gender- and time-varying postural and discomfort responses during prolonged driving

The objective of this study was to conduct gender- and time-based comparisons of postural and discomfort responses during prolonged simulated driving. Prolonged driving has been linked with low back disorders (LBD), however underlying mechanisms of pain or injury are not well understood despite many efforts to delineate the biomechanics of automobile seating. Twelve males and 12 females were exposed to one hour of simulated automobile driving. Body postures, body-seat pressure distributions, and ratings of perceived discomfort were documented and gender- and time-based comparisons were performed. Females exhibited approximately 10 ◦ greater changes in lumbo-pelvic orientation when upright standing postures were compared to those in automobile seating. Attributed to gender-based differences in body size was the finding that males experienced significantly greater body-seat interface pressures. Many of the postural, pressure, and discomfort measures varied significantly over 30 to 45 minutes, and these variations were mostly consistent between genders. Many variables examined varied as a function of gender and duration of driving. Future biomechanical investigations of automobile seating design for more effective LBD prevention should consider these potential effects in order to gain further insight into potential low back pain- or injury-generating mechanisms.

A Stochastic Framework for Movement Strategy Identification and Analysis

The human body has many biomechanical degrees of freedom, and thus, multiple movement strategies can be employed to execute a given task. Joint loading patterns and risk of injury are highly sensitive to the movement strategy employed. This paper develops a computational framework to automatically identify and recognize different movement strategies to perform a task from human motion data. A divisive clustering approach is developed to identify movement strategies. Hidden Markov models (HMMs) are trained with the clustered observation sequences to generate strategy-specific models that are improved iteratively by using the maximum likelihood to relocate sequences to the most suitable cluster. Differences in individual joint trajectories are compared across strategies using a stochastic distance measure. The proposed algorithm is compared against three existing algorithms - joint contribution vector, decision tree, and HMM-based agglomerative clustering. Experimental results indicate that the proposed approach performs better than existing algorithms to detect motion strategies and automatically determine the differences between the strategies.

Gender Responses to Automobile and Office Sitting - Influence of Hip, Hamstring, and Low-Back Flexibility on Seated Postures

Understanding factors that influence preferred sitting postures is considered important to prevent low-back pain (LBP) associated with seated exposures. The purpose of this study was to examine the influence of gender and flexibility (hip, hamstring, and low-back) on lumbo-pelvic postures adopted when performing laboratory-simulated computer work and automobile driving. Ten female and 9 male volunteers were exposed to 10 minutes each of the abovementioned sitting conditions. Sagittal lumbo-pelvic kinematics were recorded during each sitting condition. Correlation analyses were per- formed between lumbo-pelvic postures and various measures of hip, hamstring, and low-back flexibility. When driving, females exhibited 9.8 degrees more posterior pelvic tilt (p = 0.0329) and 10.5 degrees more lumbar flexion (p = 0.0116) than males with respect to their lumbo-pelvic alignments in upright standing. When performing seated computer work, it was males who experienced greater posterior pelvic tilt (p = 0.0048). Individuals with greater hip flexibility, typically fe- males, adopted lumbar flexion postures closer to their voluntary end-range while driving (r = 0.5709; p = 0.0107). Indi- viduals who exhibited greater posterior pelvic tilt in office chair sitting, typically males, were those with less hip (r = - 0.5484; p = 0.0150) and hamstring (r = -0.4690; p = 0.0496) flexibility. Given that differences exist between males and females with respect to various indices of hip, hamstring, and low-back flexibility, it is possible that gender-based differ- ences in seated postures are related to inherent differences in flexibility between the sexes. These findings suggest that strategies to prevent LBP associated with sitting may depend on both individual flexibility characteristics and the type of seated exposure.

The influence of precision requirements and cognitive challenges on upper extremity joint reaction forces, moments and muscle force estimates during prolonged repetitive lifting.

Prolonged repetitive lifting is a whole-body exertion. Despite this, the roles and physical exposures of the upper extremities are frequently neglected. The influence of precision requirements and cognitive distractions on upper extremity responses when lifting was evaluated by quantifying several biomechanical upper extremity quantities. Nine participants completed four 30-min lifting tasks with and without simultaneous cognitive distractions and/or precision placement constraints. Specific metrics evaluated were joint reaction forces and moments (wrist, elbow and shoulder) and modelled shoulder muscle forces (38 defined shoulder muscle mechanical elements). The addition of a precision requirement increased several metrics by up to 43%, while the addition of the cognitive distraction task had minimal influence. Furthermore, several metrics decreased by up to 14% after the first 10 min of lifting, suggesting a temporal change of lifting strategy. Practitioner Summary: Lifting tasks often include precision placements and cognitive demands. This study shows that precision placement during prolonged repetitive lifting increases upper extremity forces and moments, while the addition of a cognitive task is benign. Furthermore, field assessments of repetitive lifting should include observations longer than 10 min, as adaptive strategies appear to be adopted.

Is there a low-back cost to hip-centric exercise? Quantifying the lumbar spine joint compression and shear forces during movements used to overload the hips

Abstract The aim of this study was to quantify joint compression and shear forces at L4/L5 during exercises used to overload the hips. Nine men performed 36 “walking” trials using two modalities: (1) sled towing and (2) exercise bands placed around the ankles. Participants completed forward, backward, and lateral trials with bent and straight legs at three separate loads. Surface electromyography (EMG) was recorded bilaterally from eight torso and thigh sites, upper body and lumbar spine motion were quantified, and hand forces were measured. An EMG-driven musculoskeletal model was used to estimate the muscular contribution to joint compression and shear. Peak reaction, muscle and joint compression and shear forces, and peak gluteus medius and maximus activity were calculated. Significant differences were noted in each dependent measure; however, they were dependent on direction of travel, leg position, and load. The highest joint compression and shear forces for the sled and band conditions were 4378 N and 626 N, and 3306 N and 713 N, respectively. In general, increasing the band tension had little effect on all dependent measures, although a load-response was found during the sled conditions. Before using any exercise to improve hip function, the potential benefits should be weighed against “costs” to neighbouring joints.