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The key to understanding the link between occupational twisting and the incidence of low back pain
is to elucidate the mechanisms that contribute to
twisting injury. Axial trunk twisting and the generReceived June IS, 1989; accepted March 20, 1990.
Address correspondence and reprint requests to Dr. S.
McGill, Occupational Biomechanics Laboratory, Department of
Kinesiology, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1.
91
92
S.M . McGILL
example, there is no trunk muscle specifically designed to produce axial rotation because the generation of axial torque is coupled with the production
of either lateral bending or sagittal plane torque, or
both. While electromyographic investigations of
muscle activity have been performed during the
generation of isometric torque (17), the muscular
response throughout the twisting range of motion
remains poorly understood. Electromyography provides information, within certain limitations, about
the neural drive to various components of the musculature. In addition, such information on activation, combined with geometric modeling of the musculoskeletal tissues, constitutes a powerful tool to
increase functional understanding of the twisting
mechanism of the trunk and related injury.
The acquisition of electromyographic signals is
difficult, and the raw, unprocessed form of the signal possesses little information content. Often the
raw signal is rectified and low pass filtered (linear
envelope) (26) to forge a link between the raw muscle activation signal and force production. To further enhance physiologic interpretation, the signal
is often normalized to, or expressed as a percentage
of, the maximum electrical activity (MEA) obtained
during a static maximum voluntary contraction
(MVC). However, whereas voluntary efforts that
produce maximum myoelectric signals from some
muscles have been published (27), the method to
achieve maximum signals for normalization from
the trunk musculature remains to be established.
This is a critical issue for those models of the low
back that use myoelectric signals as neural drive to
the modeled muscles. This issue constitutes the first
aspect of this study.
The remaining aspects reported in this study deal
with muscle activation during twisting. The relationship between torque and myoelectric signal amplitude in the trunk has been addressed by several
researchers. Both Stokes et al. (23) and Vink et al.
(24) demonstrated linear and curvilinear electromyogram to isometric extensor torque relationships, whereas Seroussi and Pope (21) demonstrated a linear relationship for isometric holds of
extension efforts (2 = 0.96) and for the difference
between left and right erector spinae myoelectric
activity and the lateral bending torque (3= 0.95).
Pope et al. (18) demonstrated curvilinear relationships between the rectus abdominis, abdominal obliques, and erector spinae during the production of
isometric axial torque. However, several issues remain unanswered regarding the monitoring of mus-
cle activity during both isometric efforts and dynamic twists. For example, are there individual differences in muscle recruitment patterns indicative
of function, and which muscles should be monitored for activity in order to obtain reasonable documentation of the torsional-twisting mechanism of
the lumbar spine?
Several studies have attempted to identify muscle
function using various forms of the electromyogram
during twisting. Jonsson (6) noted that the erector
spinae was active during twisting and speculated
that such contractions were for torque production
and/or to provide a stabilizing component to the
spine. Morris et al. (15) documented similar coactivation in erector spinae under axial twisting conditions. Pope et al. (17) summarized that the issue of
relative activity of the trunk musculature during
twisting is unclear in the literature, but agreed that
the observed cocontractions in right and left side
muscles must contribute to spine stabilization. Certainly if large discrepancies in muscle activation and
cocontraction patterns are observed between subjects, it is unlikely that a single equivalent twistingaxial torque muscle could be found to represent
muscular contributions for use in simple models intended to estimate occupational joint loads.
Given the several contentious issues presented in
this introduction, the purposes of the present study
were (a) to find a method to obtain the maximum
myoelectric signal amplitude for normalization of
the trunk musculature, (b) to examine the myoelectric activity-axial torque relationship of various
trunk muscles, and (c) to combine myoelectric signal information with an analytical model in an effort
to increase insight into muscular axial torque production.
Thus, this paper reports a series of experiments
performed on the same group of subjects in an attempt to address these issues. Each subject performed the experiments in a single session so that
the electrodes were applied once and all instrumentation settings remained constant.
METHODS
Subjects
N
Age (yr)
Height (cm)
Weight (kg)
Men
meadSD
Women
meadSD
10
2 1.218.5
173m . 7
71.417.7
5
2411.9
15914.2
53.316.7
Six pairs of bipolar, AgAgCl surface electromyogram (EMG) electrodes were attached to the skin
on the right side of the body: 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; latissimus
dorsi, lateral to T9 over the muscle belly; thoracic
erector spinae, 5 cm lateral to T9 spinous process,
and lumbar erector spinae, 3 cm lateral to L3
spinous process. These electrode locations and arrangements have been shown to best represent the
differential muscle activity patterns and minimize
signal cross-talk between electrode pairs during
bending and twisting tasks (8). In addition, Vink et
al. (23) quantified cross-talk using 12 pairs of bipolar surface electrodes over the erector spinae group
during isometric contractions of 10, 20, 30, 40, 50,
60, 70, 80, 90, and 100% MVC. Using the crosscorrelation coefficient function, they demonstrated
that the absolute maximum in the correlation coefficient was less than 0.30 (or about 10% of common
signal) when electrode pairs were placed more than
30 mm apart. They concluded that, even at the
small distance of 30 mm between electrode pairs,
myoelectric signals are specific and optimize selective recording of localized muscle activity in the
erector spinae. The distance between the electrode
pairs reported in this study were always greater
than 100 mm.
All raw myoelectric signals were prefiltered to
produce a band width of 10-500 Hz and were amplified with a differential amplifier (common mode
rejection ratio of 80 dB at 60 Hz) to produce signals
of approximately 4 V.
A torsional dynamometer for the trunk was fabricated by removing the measurement head from a
Cybex I1 commercial isokinetic dynamometer. The
93
Tasks
There were three tasks to examine myoelectric
activity reported in this paper.
MVC Trials
The first objective was to select a method of exertion that would consistently produce the largest
amplitudes of myoelectric activity from selected
trunk muscles in order to provide a basis for normalization. Four basic isometric restraint strategies
were used in which subjects attempted to produce
maximum muscle activity (Fig. 2). Three trials of
each strategy were performed. The first strategy
consisted of the subject starting in a bent-knee situp posture with the feet restrained by a strap in an
attempt to recruit the abdominals. Hands were
placed behind the head and the trunk formed an
angle with the horizontal of approximately 30". An
assistant provided a matching resistance to the
shoulders during a maximum sit-up effort. The second method consisted of subjects leaning over the
edge of the test bench with the legs restrained.
While lying on the back supine, a flexor effort was
S . M . McGILL
94
Myoelectric, axial torque, and twist position signals were AID converted (12 bit resolution) at 1,000
Hz. The sample rate of 1,000 Hz was shown by
Lafortune (7) to have no effect on amplitude domain
processing, as was done in this study, and minimal
effect on frequency domain information. Indeed, he
found that the mean power frequency of raw myoelectric signals sampled at 8,192, 4,096, and 1,024
Hz was uneffected (140.8, 140.3, and 140.2 Hz, respectively). However, when the signal was sampled
at 512 Hz, a significant decrease was noted in the
mean power frequency (131.6 Hz).
The myoelectric signals were full wave rectified
and low pass filtered (single pass, Butterworth) at a
cutoff frequency of 3 Hz, and then normalized to
the maximum activity observed during the MVC
trials. The cutoff frequency of 3 Hz was chosen in
the following way. Olney and Winter (16) reported
the frequency response of the rectus femoris to be
between 1.0 and 2.8 Hz during walking, whereas
Milner-Brown et al. (13) reported approximately 3
Hz in the first dorsal interosseous. In addition, the
3 Hz cutoff produced an impulse response (time to
peak) of 53 ms which is compatible with the 30-90
ms contraction times reported by Buchthal and
Schmalbruch (1).
Torsion Model of the Trunk
Anatomical Description
95
standing
L
sit up
hanging
@-
flex
twist
F,
MS
x CS x K,
MSMEA
where F, = muscle force (N), K = force production per cross-section (N/cm2), CS = muscle crosssectional area (cm2), MS = myoelectric signal, and
MS,,A
= maximum myoelectric signal amplitude
observed during normalization contraction. Previous experiments suggested that the lumbar musculature produced force as a function of cross-section
at approximately 35 N/cm2 to 50 N/cm2 (10). These
values were well within the range reported in the
literature (3). Muscle forces were estimated in this
study assuming a force potential of 35 N/cm2. The
axial torque potential of each muscle was then calculated from the 3-D triple scalar product of muscle
force about the twisting axis of L4/L5. Estimates of
total torque were obtained from the sum of the agonist muscle forces. This process is described in the
matrix below.
Kinetics
Maximum muscle forces were estimated by multiplying the physiologic cross-sectional area by a
value of force production per cross-sectional area
according to equation 1 .
S. M . McGILL
96
Sex
(11 M, 5 F)
Rectus abdominis
Internal oblique
M
F
M
F
M
Latissimus dorsi
F
M
External oblique
F
M
F
M
F
Method
9 hang-flex, 1 sit-up, 1 stand-flex
4 hang-flex, 1 twist 30" cw
5 sit-ups, 2 hang-lat bends, 2 hang-flex, 1 stand-flex, 1 twist 30" cw
3 hang-lat bends, 1 hang-flex, 1 sit-up
3 stand-lat bends, 3 twists 30" cw, 2 twists 0" cw, 1 twist 30" cw, 1 hang-lat bend, 1
sit-up
2 hang-lat bends, 1 hang-flex, 1 twist 30" cw, 1 twist 0" cw
3 twists 30" cw, 2 twists 30" cw, 2 stand-lat bends, 1 hang-lat bend, 1 twist 0" cw, 1
twist 0" ccw, 1 stand-flex
2 twists 30" cw, 2 stand-lat bends, 1 twist 30" cw
4 hang-extend, 4 twists 30" cw, 1 twist 30" cw, 1 stand-lat bend
4 hang-extend, 1 twist 30" cw
11 hang-extend
5 hang-extend
97
TABLE 3. Peak torque and right side muscle activity expressed as a % MVC during isometric exertions
0" cw
M
F
0" ccw
M
F
+30" cwa
M
F
+ 30" ccw"
M
F
- 30" cw
M
F
- 30" ccw
M
F
Peak
torque
(N.m)
Rectus
abdominus
External
oblique
Internal
oblique
Latissimus
dorsi
Upper
erector
spinae
Lower
erector
spinae
87 (17)
39 (7)
16 (1 1)
14 (11)
28 (10)
21 (8)
55 (21)
37 (22)
64 (12)
56 (15)
46 (19)
33 (11)
23 (10)
95 (16)
41 (11)
15 (11)
21 (24)
50 (13)
32 (10)
16 (12)
16 (10)
15 (10)
17 (11)
12 (12)
7 (5)
26 (14)
8 (4)
62 (14)
25 (8)
10 ( 5 )
11 (10)
27 (13)
20 (9)
51 (20)
31 (18)
66 (17)
66 (19)
61 (17)
50 (23)
33 (15)
26 (11)
96 (18)
44 (5)
19 (16)
16 (15)
44 (18)
28 (12)
15 (11)
14 (4)
11 (7)
10 (5)
12 (14)
5 (3)
16 (7)
4 (2)
102 (18)
44 (7)
21 (13)
22 (26)
26 (10)
16 (6)
51 (18)
31 (16)
64 (16)
53 (19)
49 (17)
41 (24)
20 (12)
16 (7)
65 (17)
29 (8)
12 (10)
12 (13)
52 (18)
37 (14)
16 (15)
14 (7)
21 (14)
23 (16)
13 (15)
5 (4)
26 (14)
10 (9)
Values are the mean (males, 10 subjects x 3 trials for 30 observations; females, 5 subjects
deviation.
a + 30" corresponds to a prerotated twist that results from a cw twist.
74 (13)
S . M . McGILL
98
A
Internal oblique
V
75
External oblique
50
50
25
25
j'
f
0
0
25
50
25
50
Torque (N-m)
75
75
&
--t
50
50
25
25
25
50
25
50
25
50
FIG. 3. EMG-torque relationships for one subject (cw [A] and ccw [B]) and for another (cw [C] and ccw [D]). No consistent linear
or curvilinear relationships were observed. However, there is a relationship between muscle activity and the direction of twist
effort. (Continued)
nally measured, net torque. To address normalization concerns , a second normalization strategy was
adopted and tested. This involved normalizing the
average myoelectric signals to the maximum myoelectric signal amplitude observed only during maximal isometric twisting efforts in the neutral upright
standing posture. In other words, the myoelectric
signal amplitude produced during a twist was normalized to only a twisting effort. The model predicted that antagonists produced 58 N.m, whereas
the agonists produced 86 N.m for a net torque of 38
N.m. Some individual muscle forces are shown in
Table 4 for both normalization strategies.
DISCUSSION
The task of finding a method that consistently
produced maximum myoelectric signals for all subjects proved difficult. While motivational factors
have been identified to alter torque measurements
during MVC efforts ( 5 ) the subjects in this study
were well aware of the importance to put forth a
maximum effort. In addition, it was felt that fatigue
was not a factor during the MVC tests due to the
brief duration of contraction effort. Hence, the inconsistency of results demonstrated the importance
of attempting several exertion tasks when a mea-
99
--)t
rx"
60
rt
40
-8-
External oblique
40
Rectus obdorntnls
tnternof oblique
20
20
"E
0
0
25
50
50
25
69
40
40
-+--t
$*
40
Lotissirnus dorsi
20
20
20
25
50
25
50
25
50
FIG. 39
Nonetheless, our low values of activation were similar to those reported by Miller and Schultz (12) for
maximal twists (for example, they reported 13%
MVC, rectus abdominis; 18%, erector spinae at L3
for the right side during cw efforts; and 20% MVC,
rectus abdominis; 26%, erector spinae at L3 for ccw
efforts). Perhaps these low levels of activity indicate the presence of some form of inhibitory mechanism that serves a protective function to the spinal
tissues under stresses that are generated during axial torsion efforts. Perhaps these trunk muscles are
required to balance flexion-extension and lateral
bending moments and thus are limited in their contributions to axial torque. It was suggested by
Schultz et al. (20) that some muscles function to
counterbalance flexion and lateral bending moments that are produced by the primary axial torque
S. M . McGILL
100
50
-++
Exlernol oblique
J
t
25
50
75
50
25
50
25
7:
7:
Torque ( N - m )
75
25
50
75
25
50
75
25
50
75
FIG. 3C
101
0
0
25
50
75
I00
Torque (14-rn)
20.
0
25
75
50
\ 00
25
50
75
100
FIG. 3D
signal amplitude obtained-regardless of the isometric position-is necessary to satisfy the net
torque requirements about the three orthopaedic
axes in the low back. Perhaps the model is anatomically incorrect. However, the vector cosines and
moment arms of all muscles were checked in three
dimensions with CT scan and cadaveric data. It is
doubtful that anatomical inaccuracies would account for the discrepancies in measured and modeled torque. Such a large underprediction of net
torque suggests that other factors, as yet unknown,
influence axial torque production that are not incorporated into the model at this stage of model development.
_____
---__.__-
CONCLUSION
Since subjects exhibited variability in the posture
to obtain maximum muscle activity, it appears that
the use of several maximum exertion postures,
rather than a single posture, should be encouraged
when seeking maximum activity for myoelectric
signal normalization.
Myoelectric signal-axial torque relationships are
not always linear or nonlinear between muscles or
between subjects, although it should be noted that
the torque contribution of a single muscle cannot be
partitioned from other contributors during production of axial torque. Correspondingly, differences
between the right and left upper erector spinae during twisting in the cw and ccw directions, coupled
102
C,D
S . M . McGILL
80
80.
TORQUE
RA
+ RA
60 - -% EO
if
60
TORQUE
-+
EO
10
8-
10
LD
7C-
LD
*
4o -+UES
A LES
20 -
-#t0
Normalization (A)
Muscle
Activation
(% MVC)
Force
(N)
Torque
(N.m)
Activation
(% MVC)
Force
(N)
Torque
(N.m)
16
15
56
53
1
-1
100
83
350
291
-3
28
50
112
200
8
- 15
50
100
200
400
15
- 30
55
16
180
52
- 12
100
44
230
144
-21
9
74
15
104
21
-4
1
100
23
140
32
-6
1
56
12
353
76
-1
0
100
20
630
126
-2
0
33
26
932
733
3
2
100
70
2825
1978
-11
9
Rectus abdominis
R
L
External oblique
R
L
Internal oblique
R
L
Latissimus dorsi
R
L
Upper erector spinae"
R
L
Lower erector spinaeb
R
a For a maximal isometric twisting effort at 0" of twist, assuming two strategies for EMG normalization: (A) normalize to maximum
activity in any posture and (B) normalize to maximum activity observed in an isometric twisting effort.
R, right; L, left.
a Upper erector spinae is comprised of the thoracic portions of longissimus thoracis and iliocostalis lumborum.
Lower erector spinae is comprised of the pars lumborum components of longissimus thoracis and iliocostalis lumborum and
multifidus.
REFERENCES
1. Buchthal F, Schmalbruch H: Contraction times and fibre
types in intact human muscle. Acta Physiol Scand 79:43552, 1970
2. Carlsoo S : The static muscle load in different work positions: An electomyographic study. Ergonomics 4: 193, 1961
3. Farfan H: Mechanical disorders of the low back. Philadelphia: Lea & Febiger, 1973
4. Fick R Handbuck der Antomie und Mechanik der Gelenke
unter, Berucksichtigung der bewegenden muskeln. Jena,
East Germany: Fisher, 1910
5 . Ikai M, Steinhaus AH: Some factors modifying expression
of human strength J Appl Physiol 16:157-63, 1961
6 . Jonsson B: The lumbar part of the erector spinae muscle: a
technique for electromyographic studies of the function of
its individual muscles [Thesis] Gothenburg, Sweden: Elanders, 1970
7 . Lafortune D: The variability of EMG amplitude and frequency measures obtained from selected trunk musculature
during sagittal plane and twisting lifts [M.Sc. thesis]. Waterloo, Canada: University of Waterloo, 1988
8 . Lafortune D, Norman RW, McGill SM: Ensemble average
linear enveloped EMGs during lifting. In: Proceedings of the
biannual conference of the Canadian society for biomechanics. Ottawa, Canada, August 1988:92-3
9 . Lippold OCS: The relation between integrated action poten-
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