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The Relationship Between Lumbar

Spine Load and Muscle Activity


During Extensor Exercises

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Background and Purpose. There have been no previous studies that
quantitatively assessed the load on the spine during extensor exercises.
The purpose of our study was to investigate the loading of the lumbar
spine and trunk muscle activity levels while subjects performed typical
trunk extensor exercises. Subiects. Thirteen male volunteers (mean
age =21.0 years, SD= 1.O, range= 19-23; mean height= 176.0 cm,
SD=6.2, range= 165-188; mean mass=77.0 kg, SD=7.0, range=63-89)
participated. Methods. The subjects performed four different back
exercises. Electromyographic (EMG) activity was recorded from 14
trunk muscles. The postures that corresponded to the maximum
external moment were identified and quantified using rigid body
modeling combined with an EMGdriven model to determine joint
loading at the L4-5 joint. The exercises were then evaluated based on
the lumbar spine loading and peak muscle activity levels. A reference
task of lifting 10 kg from midthigh was included for comparison.
Results. The exercises involving active trunk extension produced the
highest joint forces and muscle activity levels. Exercises involving leg
extension with the spine held isometrically demonstrated asymmetrical
activity of the trunk muscles, thereby reducing loads on the spine.
Conclusion and Discussion. The back extensor exercises examined
provided a wide range of joint loading and muscle activity levels.
Single-leg extension tasks appear to constitute a low-risk exercise for
initial extensor strengthening, given the low spine load and mild
extensor muscle challenge. When combined with contralateral arm
extensions, the challenge and demand of the exercise were increased.
The compressive loading and extensor muscle activity levels were
highest for the trunk extension exercises. [Callaghan JP, Gunning JL,
McGill SM. The relationship between lumbar spine load and muscle
activity during extensor exercises. Phys Ther. 1998;78:8-18.1

Key Words: Electromyography, Extensor exercise, Injury, Lumbar spine, Rehabilitation.


Jack P Callaghan
Jennifer L Gunning
Stuart M McGill

Physical Therapy . Volume 7 8 . Number 1 . January 1998


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ow back extensor exercises are used for a variety ness and safety of exercise programs in various reports8
of reasons, but mainly for rehabilitation of the may be due to the prescription of inappropriate exer-
injured low back, prevention of injury, and as a cises. Specifically, a poorly selected exercise could exac-
component of fitness training programs to erbate an existing injury by excessively loading the
enhance performance levels. The objective of exercise is damaged structure.
often to place stress on both damaged and healthy
supporting tissues to foster tissue repair and strengthen- Although some exercises for the low back have been
ing while avoiding excessive loading that can exacerbate recommended for their capacity to maximize muscle
existing structural weakness. From our experience, many a c t i ~ i t y , ~virtually
,l~ none have been examined by analyz-
traditional extensor exercises generate high spinal loads ing the forces they generate on the spine. Fortunately,
as a result of externally applied compressive and shear sophisticated techniques are being developed that facil-
forces (either from free weights or resistance machines). itate investigation of the loads that lead to injury in a
Although knowledge of tissue forces is important to variety of possible injury sites. Knowledge of the tissue
avoid further injury, little work has been performed to loads is necessary to permit the testing of hypotheses
quantify these forces during trunk exercises. The overall designed to reduce the risk of injury, from a preventative
objective of our research was to examine the load on the standpoint, and to optimize the loading that results from
low back together with muscle activity levels during various rehabilitation programs for the injured.
typical back extensor exercises.
The purpose of our research was to quantitatively iden-
Thc reported effectiveness of various training and reha- tify exercises that optimized the challenge to extensor
bilitation programs for the low back is quite variable, muscles, which stabilize and support the low back, while
with some authors claiming great success but other simultaneously placing minimal load on the lumbar
authors reporting no, or even negative, re~u1ts.l.~ The spine. We hypothesized that some low back extensor
cause of this tissue damage has been attributed to exercises result in higher extensor muscle activity levels
excessive spine f l e ~ i o n , ~disadvantageous
-~ muscle but lower lumbar spine loading due to the lack of muscle
lengths in some postures,%r inappropriate orientation co-contraction.
of internal structures of the torso with respect to the
legs.7 The contradictory findings regarding the effective-

JP Callaghan is a Doctoral Student, Department of Kinesiology, University of M'aterloo, Waterloo, Ontario, Canada.

JL Gunning is a Master's Student, Department of Kinesiology, University of Waterloo.

SM McGill, PhD, is Professor, Occupational Bion~echanicsand Safety Laboratories, Department of Enesiology, Faculty of Applied Health Sciences,
University of Waterloo, MTaterloo,Ontario, Canada, N2L 3G1 (mcgill@healthy.uwaterloo.ca). Address all correspondence to Dr McGill.

This study was approved by the Hurnan Research Ethics Committee of the University of M'aterloo's Office of Human Research and Anirnal Care.

This research was funded by financial assistance of the Natural Science and Engineering Research Council, Canada.

This afiicle was submztted Januaq 24, 1997, and was accepted July 8, 1997.

Physical Therapy . Volume 7 8 . Number 1 . January 1998 Callaghan et al . 9


similarly and have similar muscle activ-
ity and load levels was not studied.
Informed consent was obtained from
all subjects.

Instrumentation
Fourteen pairs of Medi-Trace dispos-
able silver-silver chloride surface elec-
tromyogram (EMG) electrodes* were
applied to the skin bilaterally over the
following muscles: rectus abdominis, 3
cm lateral to the umbilicus; external
oblique, approximately 15 cm lateral to
the umbilicus; internal oblique, below
the external oblique electrodes and just
superior to the inguinal ligament; latis-

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simus dorsi, lateral to T-9 over the
muscle belly; thoracic erector spinae, 5
cm lateral to the T-9 spinous process;
Figure 1. lumbar erector spinae, 3 cm lateral to
Exercises 1 and 2 involved extension of the leg to the horizontal. The exercise was performed
for both legs (right leg extension and left leg extension). The posture shown was chosen as
the L 3 spinous process; and multifidus,
representing the most challenging instant. 3 cm lateral to the L-5 spinous pro-
cess.ll Prior to data collection, all s u b
jects performed maximal isometric
contractions for all monitored muscle
groups to allow EMG normalization.
Procedures for obtaining maximum
EMG activity for normalization have
been explained previously by McGill.12
Briefly, three tasks were used to elicit
maximum EMG activity from the 14
recorded sites. The abdominal muscle
groups were recruited with a modified
bent-knee sit-up, the trunk extensors
were activated by cantilevering the
trunk over the end of the bench, and
the latissimus dorsi muscle was re-
cruited with a simulation of a lateral
pull-down exercise. All three maximal
effort tasks were performed against an
equal resistance (isometric) supplied
by the experimenter. The raw EMG
Figure 2. signal was prefiltered to produce a
Exercises 3 and 4 involved extension of the contralateral arm combined with leg extension. The
posture shown was used to represent the instant of peak loading. Both sides of the body were bandwidth of 20 to 500 Hz and a m ~ l i -
exercised (right leg and left arm extension and left leg and right arm extension). fied with a differential amplifier (com-
mon-mode rejection ratio greater than
90 dB at 60 Hz and input impedance
Method greater than 10 MR above 1 Hz) to produce peak-tepeak
amplitudes of approximately 2 V. The amplified signal was
Subjects analog-todigitally (A/D) converted at 1,024 Hz.
Thirteen male volunteers were recruited from a uni-
versity student population (mean age=z1.0 Years, A sagittal view of each subject's right side for all trials was
SD=1.0, range=19-23; mean height=176.0 cm, SD=6.2, recorded on videotape, at a frame rate of 30 Hz, to allow
range=165-188; mean mass=77.0 kg, SD= 7.0, range=
63-89). None of the subjects had experienced any low
back pain for a minimum year' Therefore, whether Graphic Controls Canada Ltd, 215 Hebert St, Gananoque, Ontario, Canada
patients with low back pain would perform the exercises K7G 217.

10 . Callaghan et al Physical Therapy. Volume 78 . Number 1 . January 1998


flexion and extension moments about
the L4-5 joint to be calculated. A trans-
verse-plane view was also recorded for
two exercises (single-leg extensions) to
allow the twist moment about the L4-5
joint to be determined. Lumbar curva-
ture was monitored with a 3SPACE
ISOTRAK~and was A/D converted at
20.5 Hz using customized software
developed at the Occupational Biome-
chanics and Safety Laboratories at
the University of Waterloo (Waterloo,
Ontario, Canada). The ISOTRAK source,
which produces an electromagnetic

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field, was mounted on the sacrum using
a custom-built harness, and the sensor,
which detects the rotational motion
(three-directional cosines) with respect
to the source, was mounted over the
trunk midline at the T12-L1 spinal
Figure 3.
level. Active trunk extension combined with leg extension was the fifth exercise. From a prone posture
on the floor, subjects performed active trunk and leg extension (maximum comfortable) and
Synchronization of the ISOTRAK, EMG, returned to the prone position.
and video signals was accomplished in
the following way. At the beginning at
the trial, the computer controlling the
ISOrRAK sent a pulse through the A/D
converter of a second computer (at 1,024
Hz), which initiated collection of the
EMG signals. The same synchronized
pulse activated a lightemitting diode in
the field of view of the camera to mark
the begmning of the trial. Later, selected
samples from the A/Dconverted data
were matched with the appropriate video
frame (at 30 Hz).

Data Collection
Seven exercises were performed to
determine the level of muscle activity
and spinal loading. For the first four
exercises, the subjects were positioned
on their hands and knees. Exercises 1
and 2 consisted of a single-leg lift, per- I - -

formed by extending one leg out to the Figure 4*


Exercise 6 involved a large range of motion. The starting position was a fully flexed posture,
and returning it to the start-
followed by active extension until the trunk was horizontal to the ground, which corresponded
ing position. The right 1% was lifted in to the peak loading posture (shown here).
exercise 1, and the left leg was lifted in
exercise 2 (Fig. 1). Exercises 3 and 4
coupled the leg extensions of exercises 1 and 2 with the the left leg and the right arm. For exercises 5 and 6, the
simultaneous raising of the contralateral arm to the subjects were in a prone position. In exercise 5 (Fig. 3),
horizontal before returning the extended leg and arm to the upper body and legs are raised simultaneously from
the original position. Exercise 3 (Fig. 2) involved lifting the floor to a maximal comfortable elevation, with active
the right leg and the left arm. Exercise 4 required lifting spine extension, before being returned to the starting

Polhemus, Division of Kaiser Aerospace Electronics Corp, PO Box 560, Colches-


ter, IT 05446.

Physical Therapy . Volume 78 . Number 1 . January 1998 Callaghan et al . 11


position. The trunk was cantilevered over a bench in repetition of an exercise were averaged for each of the
exercise 6 (Fig. 4). A velcromTstrap fastened proximally 14 EMG channels.
to the ankle was used to secure the lower limbs to the
bench. The exercise started with the subjects in a fully A representative posture of maximum extension was
flexed posture followed by trunk extension until the identified using synchronized ISOTRAK data for all
trunk was parallel with the ground. For each of these exercises. The corresponding videotaped data were dig-
exercises, 10 seconds was allotted to perform one trial itized using a video capture system. Scaled joint coordi-
that consisted of three repetitions of the movement in nates were obtained with the use of customized software
succession. Subjects rested for at least 1 minute between and were used to calculate extensor moments about the
trials. The seventh exercise was performed to allow a L4-5 joint for all exercises as well as twist moments for
calibration of EMG activity to an external moment. exercises 1 and 2, using typical two-dimensional rigid
Subjects stood with feet shoulder width apart and knees link-segment modeling.
slightly bent. Holding a 10-kg weight in front of them,
with arms hanging straight down, they positioned their A Brief Description of the Laboratory Modeling ro roach
trunk at an angle of 60 degrees from the vertical, lndividual tissue loads have been predicted from a
maintaining a lordotic curvature of the spine. This laboratory technique and model developed over the past

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posture was held for 10 seconds. 14 years by McGill and ~ o l l e a g u e s The. ~ ~ model
~~ is
composed of two distinct parts. First, a rigid link-segment
Three repetitions of all exercises were performed, for a representation of the body was used to calculate reaction
total of 21 exercises per subject. The order of exercises forces and moments about a joint in the low back (the
was randomly assigned. For exercises 1 and 2, sagittal L4-5 joint, as previously described by McGill and Nor-
and transverse views were filmed on videotape. Sagittal manl6).Joint displacements were recorded on videotape
views were filmed for exercises 3 through 7. at 30 Hz to reconstruct the joints and body segments.
The first part of the model produces the reaction forces
Data R.&hcti~n and corresponding moments about the axes of the low
The peak loading experienced by the subjects during the back (flexion and extension, axial twist). The second
back exercises was the foclls of this study. We therefore part of the anatomically detailed model allows the
analyzed the postures representing this component of partitioning of the reaction moments obtained from the
the exercises. link-segment model into the substantial restorative
moment components (supporting tissues) using an ana-
The ISOTRAK data, representing lumbar curvature, tomically detailed, three-dimensional representation of
were used to determine the interval of maximum spinal the skeleton, muscles, ligaments, nonlinear elastic inter-
extension. A window containing the point of maximal vertebral disks, and so on. This part of the model was
extension and 1 degree before and after it was selected. first described by McGill and Norman,Ihnd full three-
This interval also represented the greatest extensor dimensional methods were described by McGill.14 The
moment, as identified from the videotape analysis. The most recent version of this part of the model, in which a
intervals chosen for each repetition of an exercise were total of 90 low back and torso muscles are represented,
averaged to obtain a single value of spinal curvature. was described by Cholewicki and McGill.15
Spinal curvature was normalized to the curvature during
relaxed upright standing (ie, 0"). Defining the posture First, the passive tissue forces are predicted by assuming
of the lumbar spine during the normal standing position stress-strain or load-deformation relationships for the
as 0 degrees (the reference point between flexion and individual passive tissues. These passive forces are indi-
extension) allows the amount of spine motion to be vidualized for the differences in flexibility of each sub-
quantified within each individual and provides a com- ject by scaling the stress-strain curves to the passive range
mon definition of the zero point for comparison of motion of the subject. The active range of motion was
between individuals. detected by electromagnetic instrumentation that mon-
itors the relative lumbar angles three-dimensionally.
Digital processing of the raw EMG signals included Once the contributions of the passive tissues to moment
full-wave rectification followed by a Butterworth low-pass restoration have been calculated, the remaining
filter (2.5-Hz cutoff frequency) to produce a linear moment is then partitioned among the many laminae of
envelope. The filtered signals were then normalized to muscle based on their EMG profile and their physiolog-
the maximum muscle activity that was elicited during the ical cross-sectional area and modulated with known
isometric contractions and synchronized to the ISO- relationships for instantaneous muscle length and either
TRAK signal. The corresponding EMG windows for each shortening or lengthening velocity (force velocity
described by Sutarno and McGi1ll7). This method of
using biological signals to solve the indeterminacy of
:Velcro U S 4 Inc, 406 Brown Axe, Manchester, NH 03108. multiple load-bearing tissues facilitates the assessment of

12 . Callaghan et al Physical Therapy . Volume 78 . Number 1 . January 1998


Table.
Mean Activation Levels ( 21 SD) of the 14 Electromyographic Channels for the 13 Subiects Expressed as a Percentage of Maximal Voluntary
Contraction

Extension
Electromyographic Right Leg Left Leg and Trunk Calibration
Channela Right Leg Left Leg and Left Arm Right Arm and Legs Trunk Posture

Right
- RA
X 3.3 2.7 4.0 3.5 4.7 3.1 1.4
SD 2.4 1.9 2.0 2.0 2.2 1.8 1 .O
Right
- EO
X 8.4 4.9 16.2 5.2 4.3 3.7 1 .O
SD 4.9 1.5 6.0 2.3 2.5 1.7 0.6
- 1
Right 0
X 12.0 8.2 15.6 12.0 12.1 12.7 1.9

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SD 6.8 2.5 8.2 4.2 10.1 10.8 1.2
Right
- LD
X 8.1 5.8 12.0 12.5 11.2 6.5 5.9
SD 5.4 3.5 9.6 6.2 4.3 4.0 8.5
Right
- TES
X 5.7 13.7 11.5 46.8 66.1 45.4 21.0
SD 2.0 7.5 6.6 29.3 18.8 10.6 9.0
Right
- LES
X 19.7 11.7 28.4 19.4 59.2 57.8 21.3
SD 9.1 4.9 10.2 11.0 11.7 8.5 4.6
Right
-
MF
X 21.9 10.8 31.5 16.1 51.9 47.5 16.4
SD 6.3 6.0 8.2 12.0 14.7 12.3 5.6
Let RA
X 4.3 3.6 4.4 4.2 6.5 3.7 2.2
SD 3.4 3.6 3.8 3.9 3.4 2.4 2.1
Let EO
X 5.4 9.0 6.2 15.9 6.3 5.2 1.8
SD 2 .O 3.8 2.5 6.6 3.2 5.2 1 .O
Let I0
X 16.0 11.3 22.6 15.2 11.0 12.5 1.6
SD 8.6 7.0 9.2 6.7 5.9 6.1 1.3
Let LD
X 4.5 5.0 10.7 6.2 9.2 5.1 6.1
SD 4.3 4.5 18.2 4.4 5.1 4.1 8.5
Let TES
X 15.0 4.5 42.9 10.5 63.6 41.6 21.2
SD 7.5 2.0 20.5 5.9 22.7 10.0 9.8
Let LES
X 11.3 16.8 19.5 25.5 56.8 57.0 23.3
SD 6.6 4.5 7.4 7.3 14.5 14.7 8.4
Let MF
X 11.9 22.3 16.6 33.8 57.3 53.3 18.7
SD 7.0 6.1 7.2 6.7 11.4 12.0 4.3
"Electromyographic channel: RA=rectus abdominis muscle, EO=external oblique muscle. IO=internal oblique muscle, LD=latissimus dorsi muscle, TES=
thoracic erector spinae muscle, LES=lumbar erector spinae muscle, MF=multifidus muscle.

the many ways that we choose to support loads, an must be assumed along with other variables that are
objective that we believe is necessary for evaluation of known to affect force production. Furthermore, accu-
various tasks prescribed in exercise and rehabilitation rate anatomical detail is essential to satisfy the moment
programs. requirements about all three joint axes and about several
joints simultaneously.
Although the major asset of this biologically based
approach is that muscle co-contraction is fully accounted A major drawback of the EMGbased approach is the
for together with being sensitive to the differences in the inaccessibility of the deeper torso muscles (eg, psoas,
way that individuals perform a movement, estimations of quadratus lumborum, three layers of the abdominal
muscle force based, in part, on EMG signals are prob- wall) to EMG analysis. In an attempt to address this
lematic because the force per muscle cross-sectional area drawback, McCill et alls used indwelling intramuscular

Physical Therapy. Volume 78 . Number 1 . January 1998 Callaghan et al . 13


6,000-

5,000- -

- T
4,000-~

f.
C
.-0 T

3,000 ~~

5
E

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0

2,000- -

1,000- -

07 w .
RL LL RL & LA LL & RA T&L T Cal~brat~on
Posture
Task

Figure 5.
Electromyographic model predictions of ioint compression (mean and standard deviation) for all trials and across all subiects (N=13). RL=right leg
extension, LL=left leg extension, RL & LA=right leg and left arm extension, LL & RA=left leg and right arm extension, T & L=trunk and leg extension,
T=trunk extension.

electrodes with simultaneous stimulation of surface elec- system. The two trunk extension trials (trunk and leg
trode sites to evaluate the possibility and validity of using extension, trunk extension) resulted in the highest
surface activity profiles as surrogates to activate deeper extensor muscle activity (Table) and in the largest
muscles over a wide variety of tasks and exercises (eg, compressive joint forces (Fig. 5). Overall, the tasks
sit-ups, curl-ups, leg raises, push-ups, spine extensor involving the lowest joint load and muscle activity levels
tasks, lateral bending, twisting tasks). Prediction of the were the two single-leg extension tasks (right leg exten-
activity of these deeper muscles is possible from well- sion, left leg extension). Leg extension coupled with
chosen surface electrodes within the criterion of 15% of contralateral arm extension (right leg and left arm
maximal voluntary contraction (root mean square extension, left leg and right arm extension) increased
difference) . I 8 the joint compression forces (1,000 N, P<.001) and
upper erector spinae muscle activity levels (30%,
One-way (dependent variable=task, a=.05) repeated- P<.0001) compared with single-leg extension.
measures analyses of variance were performed on all 14
EMG channels, lumbar compression, and shear loading The joint compressive force showed an increase with
results. Tukey's Post hoe multiple comparisons were used increasing demand of the exercise when single-leg
to examine tasks when a difference was found. extension was compared with combined arm and leg
extension (1,000 N, P <.001) and combined arm and leg
Results extension was compared with trunk extension (1,200 N,
Tasks involving active trunk extension against gravity P<.001). Due to the different loading of the tasks
produced the highest demands on the musculoskeletal involving leg extension and those requiring trunk exten-

14 . Callaghan et ol Physical Therapy . Volume 78 . Number 1 . January 1998


500 -

400 ~-

-
300 -~ I

200 - -

-t

111'
al
loo - -
2
0
LL
sal

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0-
f A.

l o o
-200
-300

--

-400-
RL LL RL & LA L L & RA T&L T Cal~brat~on
Posture
Task

Figure 6.
Anteroposterior joint shear forces (mean and standard deviation] calculated by the electromyographic-driven model for all subiects [N=13]. A
positive shear vd~ueindicates a net anterior shear of the trunk with respect to the pelvis. See Fig.-5 caption for description of ab1;reviations.

sion (ie, upper-body versus lower-body support), the posture was chosen when the trunk was parallel to the
polarities of the anteroposterior shear forces were oppo- floor, thereby artificially creating what appeared to be a
site (Fig. 6). The magnitude of the shear forces for all neutral spine posture.
exercises, however, fell below that occurring in the 10-kg
lift and were small compared with recently suggested in Activity of the abdominal muscles was low for all tasks.
vitro tolerance level^.^^^^^ Similarly, all lateral shear mag- Both the rectus abdominis and internal oblique muscles
nitudes were negligible (Fig. 7), primarily due to the were recruited bilaterally for all tasks. The external
symmetrical nature of the tasks involving active trunk oblique muscle demonstrated increased activity on the
extension (bilateral muscle activity) and offsetting mus- same side as the active leg in all four leg extension tasks.
cle activity in the isometrically held trunk in leg exten- Activity of the latissimus dorsi muscle remained at rela-
sion. Although there were clear asymmetrical activity tively low levels for all exercises, with the highest levels
patterns for the tasks involving leg extension (ie, right associated with arm extension. The thoracic erector
erector spinae muscle activity with right leg extension), spinae muscle demonstrated the opposite pattern to the
the contralateral abdominal muscles were activated to external oblique muscle in the combined arm and leg
maintain a neutral pelvis and spine posture, in effect extension tasks and to a lesser degree in the leg exten-
balancing the internal moments and lateral shear forces. sion tasks. Increased levels of thoracic erector spinae
The lumbar curvature at the instant of peak loading muscle activity were associated with elevation of the
showed consistent low levels of spinal flexion across the ipsilateral arm. The three back extensor groups moni-
four tasks involving leg extension (Fig. 8). The active tored (thoracic and lumbar erector spinae muscles and
trunk and leg extension task resulted in an extended multifidus muscle) followed the same trend as the joint
spine posture. The trunk extension task peak load compressive force. The trunk extensor tasks required

Physical Therapy. Volume 78 . Number 1 . January 1998 Callaghan et al . 15


150

- -
-
100 - -

50 - -
-

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RL LL RL&LA LL & RA i. T&L T Cal~brat~on
Task Posture

..J"'F I .
Mediolateral ioint shear forces (mean and standard deviation)calculated from the electromyographicdriven model for all subiects (N=13). A positive
value indicates that the trunk is shearing to the subject's right with respect to the pelvis. See Fig. 5 caption for description of abbreviations.

the highest actiblty levels, whereas the leg extension tasks was used in our study showed that exercises, when
were the least demanding. performed with the low back close to neutral lordosis,
reduce disk deformation, ligament loading, and ulti-
Discussion mately spinal loading. Hyperlordosis (extension) has
Of the four typical exercises examined, only the single- been shown to shift loading to the posterior elements,
leg extension tasks provided both low joint loading and whereas hypolordosis (flexion) has been linked to a
muscular activity at a level, suggesting that these tasks lower failure tolerance of the spine,21 higher ligament
would be a wise choice for persons beginning the muscle loading,22 and a higher risk of disk herniati0n.2~The
development part of a rehabilitation program. When literature supports the importance of hip flexibility for
compared with lifting a 10-kg mass (from approximately successful low back rehabilitation. Lumbar flexibility
midthigh level), only the single-leg extension exercises remains questionable for some low back disorders, and
resulted in less joint compression. The remaining three in some cases spinal hypermobility has been associated
exercises (trunk extension, trunk and leg extension, leg with low back t r o ~ b l e .Interestingly,
~~,~~ Saal and Saa12"
and arm extension) generated high spinal loading and noted success with carefully formulated exercises that
muscle activity levels. Very little co-contraction was emphasized muscle co-contraction with the spine in a
present during any of the exercises. The hypothesis that neutral posture. The data that we report also show that
some exercises would have higher levels of extensor the tasks involving leg extension preserve a more neutral
activity with lower joint loading, therefore, was not lumbar posture and reduce spinal load because only
demonstrated for our subjects without low back pain. one side of the extensors at a time dominates the
Whether this finding would be true for persons with low contraction.
back pain is not known. The modeling procedure that

16 . Callaghan et al Physical Therapy . Volume 7 8 . Number 1 . January 1998


6-
-
6 --

-
T
4 --
- -
L
.-

2 -.

@ o- w m
f
*
%
-2..
.-eP
:

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4..
P
S
4
-6 --

-8 - -

-10 - -

12
RL LL R L & LA LL & RA T& L T
Task
J

Figure 8.
Lumbar sagittal-planespinal posture (mean and standard deviation) for all subiects (N=13) in the peak load position. A positive value indicates trunk
(T-12 level) extension with respect to the sacrum; a negative value represents lumbar spine flexion. See Fig. 5 caption for description of abbreviations.

Only male subjects without low back pain were studied, be suitable for the majority of patients who need
and they are not representative of the patients who increased endurance and strength enhancement. The
perform these exercises as a treatment for back pain. increased demand of combining arm extension with leg
Our objective, however, was to quantify muscle activity extension suggests that this exercise constitutes an
and lumbar loading. The types of tasks studied pre- increased level of challenge. Although commonly used
sented a challenge from a modeling perspective because in rehabilitation protocols, the exercises involving trunk
the subjects were positioned prone on the floor in some extension while lying prone on the floor (the prone
tasks, with contact forces distributed over their torso, press-up) require very high muscle activity levels and
making the external moment calculations more difficult. resulted in substantial joint loads, suggesting that their
This difficulty was overcome by establishing a fixed use is unwise.
relationship of maximum possible muscle stress (in
newtons per square centimeter) for each subject. This References
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18 . Callaghan et al Physical Therapy. Volume 78 . Number 1 . January 1998

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