PTJ 0008
PTJ 0008
PTJ 0008
JP Callaghan is a Doctoral Student, Department of Kinesiology, University of M'aterloo, Waterloo, Ontario, Canada.
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.
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-
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 - -
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
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
5,000- -
- T
4,000-~
f.
C
.-0 T
3,000 ~~
5
E
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-
400 ~-
-
300 -~ I
200 - -
-t
111'
al
loo - -
2
0
LL
sal
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
- -
-
100 - -
50 - -
-
..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
-
T
4 --
- -
L
.-
2 -.
@ o- w m
f
*
%
-2..
.-eP
:
-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
relationship was established during the calibration task 1 Koes AW, Bouter LM, Beckerlnan H, et al. Physiotherapy exercises
(exercise 7). Finally, although the tasks involved move- and back pain: a blinded review. BMJ 1991;302:1572-1576.
ment, measurements were taken only when the extreme 2 Battii MC, Bigos SJ, Fisher LD, et al. The role of spinal flexibility in
positions were obtained, and this generated the largest back pain co~nplaintswithin industry: a prospective study. Spine.
1990;15:768-773.
external moments and levels of muscle activity and
spinal loading. The tasks were performed smoothly and 3 Nachernson A, Morris JM. In vivo measurements of intradiscal
pressure. J B o n Jolnt
~ Surg Am. 1964;46:1077-1080.
at a slow speed, thereby reducing inertial components at
the initiation of each repetition. 4 Nachen~sonA. The load on the lumbar disks in different positions of
the body. Clin Orthop. 1966;45:107-112.
CO~C~US~O~ 5 Halpern AA, Bleck EE. Sit-up exercises: an electromyographic study.
T .--
A -A=-- -----
-.----------
h e eyerricpc eyzimined nrnvide a ranue
r--'--- - -----
-- - - - Inzidinua
a nf inint -A a - --A A a
Clzn Orthob. 1979;145:172-178.
and muscle activity levels. The leg extension tasks could
partial curl-ups as a test of muscular endurance. Canadian Jounaal of electrodes reflect deep muscle activity (psoas, quadratus lumborum,
Physical Education and Recreation. September-October 1984:4-9. abdominal wall) in the lumbar spine. J Biomech. 1996;29:1503-1507.
8 Malmivaara A, Hakkinen U, k o T , et al. The treatment of acute low 19 Krypton P, Berleman U, Visarius H , et al. Response of the lumbal-
back pain: Bed rest, exercises, or ordinary activity? N Engl J Med. spine due to shear loading. In: Pruceedingr ofthe CmtersforDisease Control
1995;332:351-355. on lnjuly Pra~mtion'I'hrouglt Biomrrhanics. Detroit, Mich: Wayne State
University; 1995.
9 Walters CE, Partridge MJ. Electromyographic study of the differential
action of the abdominal muscles during exercise. A m J Phys hfcd. 20 Mngling VR. Shear Loadzng of the Lrimbw. Spine: Modulatwrs oJ Motion
1957;36:259-268. Segnl~ntTolerance and the Resulting Injurirs. Waterloo, Ontario, Canada:
University of Waterloo; 1997. Doctoral thesis.
10 Flint MM. Abdominal muscle involvement during performance of
various forms of sit-up exercises: electromyographic study. A m J Phys 21 Adams MA, Hutton WC. Prolapsed intervertebral disc: a hyperflex-
Med. 1965;44:224-234. ion injury. Spine. 1982;7:184-191.
11 Macintosh JE, Bogduk N. The morphology of the lumbar erector- 22 Panjabi MM, Goel VK, Takata K Physiologic strains in the lumbar
back musculature during the generation of isometric and dynamic 23 Gordon SJ, Yang KH, Mayer PJ, et al. Mechanism of disc rupture: a
axial trunk torque: implications for lumbar mechanics. J Chthop Kes. PI-eliminaryreport. Spine. 1991;16:450-456.
1991;9:91-103.
24 Biering-Sorensen F. Physical measurements as risk indicators for
13 McGill SM, Norman RW. Partitioning of the L4/L5 dynamic low-back trouble over a one-year period. Spine. 1984;9:106-119.
moment into disc, ligamentous, and muscular components during
25 Burton 4 K , Tillotson KM, Troup JDG. Variation in lumbar sagittal
lifting. Spine. 1986;11:666-677.
mobility with low back trouble. Spine. 1989;14:584-590.
14 McGill SM. A myoelectrically based dynamic three-dimensional
26 Saal JA, Saal JS. Nonoperative treatment of herniated lumbar
model to predict loads on lumbar spine tissues during lateral bending.
intervertebral disc with radiculopathy: an outcome study. Splnr 1989;
,J Biomech. 1992;25:395-414.
14:431-437.
15 Cholewicki J , McGill SM. Mechanical stability of the in vivo lumbar
spine: implications for injury and chronic low back pain. Clin Biomech.
1996;ll:l-15.
16 McGill SM, Norman RW.Dynamically and statically determined low
back moments during lifting. JBiomech. 1985;18:877-885.