Xiaopeng Ning

Influence of asymmetry on the flexion relaxation response of the low back musculature.

BACKGROUNDnthe flexion relaxation phenomenon has been extensively studied in sagittally symmetric postures. Knowledge about this phenomenon in asymmetric trunk postures is less well understood, and may help to reveal the underlying physiology of the passive tissue/active tissue load-sharing mechanism in the lumbar region.nnnMETHODSntwelve participants performed fifteen controlled, full range trunk flexion-extension motions toward three asymmetric lifting postures (0° (sagittally symmetric), 15°, and 30° from the mid-sagittal plane). The electromyographic activity data from the paraspinals at the L3 and L4 levels and trunk kinematics data from motion sensors over the C7, T12 and S1 vertebrae were recorded. The lumbar flexion angles at which these muscles activities were reduced to resting levels during forward flexion provided quantitative data describing the effects of asymmetry on the passive tissue/active tissue interaction.nnnFINDINGSnflexion relaxation was observed in the muscles contralateral to the direction of the asymmetric trunk flexion motion. The response of the ipsilateral extensor musculature was much less consistent, with many trials indicating that flexion relaxation was never achieved. Increasing asymmetry from 0° to 30° led to a 10% reduction in the maximum lumbar flexion. Lumbar flexion angles necessary to achieve flexion relaxation in the contralateral muscles also decreased (L4 paraspinal-related angle decreasing by 15% and the L3 paraspinal-related angle decreasing by 21%).nnnINTERPRETATIONnunder asymmetric conditions the lumbar flexion angle at which the transition from active muscle to passive ligamentous extension moment is altered from that seen in symmetric motions and this transition can have implications for the loading of the spine in full flexion (or near full flexion) postures.

Risk Assessment of Work-Related Musculoskeletal Disorders in Construction: State-of-the-Art Review

AbstractWork-related musculoskeletal disorders (WMSDs) have long been a primary cause of non-fatal injuries in construction. They involve sudden or continuous stresses on a worker’s musculoskeletal system (e.g.,xa0muscles, tendons, ligaments, bones) and may impair the ability of the worker to perform his or her job, or even cause permanent disability. Although assessing exposure to risk factors of WMSDs has proven to be feasible to alleviate the incidence rate of this injury, the field remains underdeveloped because of a lack of knowledge among construction professionals regarding the enabling techniques and their performance and limits. This paper reviews the available techniques for WMSD risk assessments, summarizes their benefits and limitations, and identifies areas in which further studies are still needed. Current techniques are categorized into self-report, observation, direct measurement, and remote sensing assessment. Particular interests are revealed in the wearable-sensor and vision-based techniq...

The assessment of material handling strategies in dealing with sudden loading: the effects of load handling position on trunk biomechanics

Back injury caused by sudden loading is a significant risk among workers that perform manual handling tasks. The present study investigated the effects of load handling position on trunk biomechanics (flexion angle, L5/S1 joint moment and compression force) during sudden loading. Eleven subjects were exposed to a 6.8xa0kg sudden loading while standing upright, facing forward and holding load at three different vertical heights in the sagittal plane or 45° left to the sagittal plane (created by arm rotation). Results showed that the increase of load holding height significantly elevated the peak L5/S1 joint compression force and reduced the magnitude of trunk flexion. Further, experiencing sudden loading from an asymmetric direction resulted in significantly smaller peak L5/S1 joint compression force, trunk flexion angle and L5/S1 joint moment than a symmetric posture. These findings suggest that handling loads in a lower position could work as a protective strategy during sudden loading.

An algorithm for defining the onset and cessation of the flexion-relaxation phenomenon in the low back musculature

The flexion-relaxation phenomenon (FRP) in the low back provides insights into the interplay between the active and passive tissues. Establishing a reliable algorithm for defining the lumbar angle at which the muscles deactivate and reactivate was the focus of the current paper. First, the EMG data were processed using six different smoothing techniques (no smoothing, moving average, moving standard deviation, Butterworth low pass filter at 0.5 Hz, 5 Hz, and 50 Hz) herein called the processed EMG (pEMG). The FRP points were then defined using four thresholds (pEMG less than 3% MVC, pEMG less than 5% MVC, pEMG less than 2 times FRP pEMG, and pEMG less than 3 times FRP pEMG). Finally, a duration requirement was tested (no duration requirement, pEMG data must maintain threshold requirement for 50 data points). Each combination of smoothing, threshold, and duration were applied through a computer program to each muscle for all trials and established an EMG-off and EMG-on angle for each muscle. These estimates were compared to the gold standard of expert-identified EMG-off and EMG-on angles and the root mean square error (RMSE) between this gold standard and the predictions of the algorithms served as the dependent variable. The results showed that the most important factor to produce low values of RMSE is to utilize a Butterworth low pass filter of 5 Hz or less and, if this is employed, there is no value to a duration requirement. The results also suggest that using the 3 times FRP pEMG threshold technique may provide further improvements in these predictions.

Describing the active region boundary of EMG-assisted biomechanical models of the low back.

BACKGROUNDnElectromyography-assisted (EMG-assisted) biomechanical models are used to characterize the muscle and joint reaction forces in the lumbar region. However, during a full-range trunk flexion, there is a transition of extension moment from the trunk extensor muscles to the passive tissues of the low back, indicating that the empirical EMG data used to drive these EMG-assisted models becomes less correlated with the extensor moment. The objectives of this study were to establish the trunk flexion angles at which the passive tissues generate substantial trunk extension moment and to document how these angles change with asymmetry.nnnMETHODSnParticipants performed controlled trunk flexion-extension motions in three asymmetric postures. The trunk kinematics data and the electromyographic activity from L3- and L4-level paraspinals and rectus abdominis were captured. The time-dependent net internal active moment (from an EMG-assisted model) and the net external moment were calculated. The trunk and lumbar angles at which the net internal active moment was less than 70% of the external moment were found.nnnFINDINGSnThe trunk flexion angle at which the net internal moment reaches the stated criteria varied as a function of asymmetry of trunk flexion motion with the sagittally symmetric case providing the deepest flexion angle of 38° (asymmetry 15°: 33°; asymmetry 30°: 26°).nnnINTERPRETATIONnThese results indicate that EMG-assisted biomechanical models need to consider the role of passive tissues at trunk flexion angles significantly less than previously thought and these flexion angles vary as a function of the asymmetry and direction of motion.

The changes of lumbar muscle flexion–relaxation response due to laterally slanted ground surfaces

Lifting tasks performed on uneven ground surfaces are common in outdoor industries. Previous studies have demonstrated that lifting tasks performed on laterally slanted ground surfaces influence lumbar muscle activation and trunk kinematics. In this study, the effect of laterally slanted ground surfaces on the lumbar muscle flexion–relaxation responses was investigated. Fourteen participants performed sagittal plane, trunk flexion–extension tasks on three laterally slanted ground surfaces (0° (flat ground), 15° and 30°), while lumbar muscle activities and trunk kinematics were recorded. Results showed that flexion–relaxation occurred up to 6.2° earlier among ipsilateral lumbar muscles with an increase in laterally slanted ground angle; however, the contralateral side was not affected as much. Our findings suggest that uneven ground alters the lumbar tissue load-sharing mechanism and creates unbalanced lumbar muscle activity, which may increase the risk of low back pain with repeated exposure to lifting on variable surfaces. Practitioner Summary: Uneven ground surfaces are ubiquitous in agriculture, construction, fishing and other outdoor industries. A better understanding of the effects of laterally slanted ground surfaces on the interaction between passive and active lumbar tissues during lifting tasks could provide valuable knowledge in the design of preventive strategies for low back injuries.

The effects of stance width and foot posture on lumbar muscle flexion-relaxation phenomenon

BACKGROUNDnCharacterizing the lumbar muscle flexion-relaxation phenomenon is a clinically relevant approach in understanding the neuromuscular alternations of low back pain patients. Previous studies have indicated that changes in stance posture could directly influence trunk kinematics and potentially change the lumbar tissue synergy. In this study, the effects of stance width and foot posture on the lumbar muscle relaxation responses during trunk flexion were investigated.nnnMETHODSnThirteen volunteers performed trunk flexion using three different stance widths and toe-forward or toe-out foot postures (six conditions in total). Lumbar muscle electromyography was collected from the L3 and L4 level paraspinals; meanwhile three magnetic motion sensors were placed over the S1, T12, and C7 vertebrae to track lumbar and trunk kinematics. The lumbar angle at which muscle activity diminished to a near resting level was recorded. At the systemic level, the boundary where the internal moment started to shift from active to passive tissues was identified.nnnFINDINGSnFor the L3 paraspinals, the flexion relaxation lumbar angle reduced 1.3° with the increase of stance width. When changed from toe-forward to toe-out foot posture, the flexion relaxation lumbar angle reduced 1.4° and 1.1° for the L3 and L4 paraspinals respectively. However, the active and passive lumbar tissue load shifting boundary was not affected.nnnINTERPRETATIONnFindings of this study suggest that changes in stance width and foot posture altered the lumbar tissue load sharing mechanism. Therefore, in a clinical setting, it is critical to maintain consistent stance postures when examining the characteristics of lumbar tissue synergy.

The influence of lumbar extensor muscle fatigue on lumbar–pelvic coordination during weightlifting

Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar–pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar–pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar–pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Practitioner Summary: Lumbar extensor muscle fatigue generates more in-phase lumbar–pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

The assessment of material handling strategies in dealing with sudden loading: influences of foot placement on trunk biomechanics

Sudden unexpected loading has been identified as a risk factor of work-related low back pain (LBP). This study investigated the effects of different foot placements and load-releasing locations on trunk biomechanics under an unexpected sudden loading event. Fifteen subjects experienced sudden release of a 6.8-kg external load from symmetric or asymmetric directions while maintaining four different foot placements. The results showed that subjects experienced on average 4.1° less trunk flexion, 6.6 Nm less L5/S1 joint moment and 32.0 N less shear force with staggered stance with the right foot forward (the most preferred placement) compared with wide stance (the least preferred placement). Asymmetric load-releasing positions consistently resulted in smaller impacts on trunk biomechanics than symmetric positions. The findings suggest that staggered stance and asymmetric load-holding position can be used as a protective load-handling posture against LBP caused by sudden loading. Practitioner Summary: In a work environment, unexpected sudden loading may cause low back pain (LBP). In this study, we used empirical data to demonstrate how different foot placements and load-releasing locations can be used to mitigate the impact of sudden loading on the spine and to reduce the risk of LBP.

The effect of sinusoidal rolling ground motion on lifting biomechanics.

The objective of this study was to quantify the effects of ground surface motion on the biomechanical responses of a person performing a lifting task. A boat motion simulator (BMS) was built to provide a sinusoidal ground motion (simultaneous vertical linear translation and a roll angular displacement) that simulates the deck motion on a small fishing boat. Sixteen participants performed lifting, lowering and static holding tasks under conditions of two levels of mass (5 and 10 kg) and five ground moving conditions. Each ground moving condition was specified by its ground angular displacement and instantaneous vertical acceleration: A): +6°, -0.54 m/s(2); B): +3°, -0.27 m/s(2); C): 0°, 0m/s(2); D): -3°, 0.27 m/s(2); and E): -6°, 0.54 m/s(2). As they performed these tasks, trunk kinematics were captured using the lumbar motion monitor and trunk muscle activities were evaluated through surface electromyography. The results showed that peak sagittal plane angular acceleration was significantly higher in Condition A than in Conditions C, D and E (698°/s(2) vs. 612-617°/s(2)) while peak sagittal plane angular deceleration during lowering was significantly higher in moving conditions (conditions A and E) than in the stationary condition C (538-542°/s(2) vs. 487°/s(2)). The EMG results indicate that the boat motions tend to amplify the effects of the slant of the lifting surface and the external oblique musculature plays an important role in stabilizing the torso during these dynamic lifting tasks.