SPINE Velurt 23, Number bpp 86-92 11998, Lipgincon Raven Pullers The Effects of Abdominal Muscle Coactivation on Lumbar Spine Stability Mack G. Gardner-Morse, MS, and lan A. F. Stokes, PhD ‘Study Design. A biomechanical mode! of the lumbar ‘spine wes used fo calculate the effects of abdominal ‘muscle coactivation on spinal stability. ‘Objectives. To estimate the effects of abdor {muscle coactivation on lumbar spine stability, muscle {fatigue rete, snd lumbar spine compression forces. ‘Summary of Background Data. The activation of hu- ‘men trunk muscles has been found to involve coactiva- tion of antagonistic muscles, which has not been ace- quately predicted by biomechanical mod ‘Actagonistic activation of abdominal muscles might produce flexion moments resulting from abdorninal pressurization. Qualitatively, istic activity also has beon attributed to the need to stabilize the spine. ‘Methods. Spinal-losds and spinal stability wera cal- culated for maximuth and submeximum.{40%, 60% and 20%) effors in extension snd lateral bending using a previously published, anatomical ic biomechan cal model ofthe furnbar sping.and its musculature. ‘Three eifferent antagonistic abdominel muscle coactiva: tion patterns were imposed, and results were compared ‘with those found in a model with no imposed coactiva- tion. Results. Results were quantified in terms of the sum of cubed muscle stresses (Sor, which is related to the muscle fatigue rate), the rnaxdmurn: compressive loading fon the lumbar spine, and the critical value of the mus- cle stiffness peremster {q) required for the spine to be ‘stable. Forcing’ antaganistic coactivation increased sta- bility, But at the cost of at Increase in Zo, and a small increase in maximamn spinal compression. ‘Conclusions. These analyses provide estimates of the effects of antagonistic abdominal muscle coactiva ~ tion, indicating that its probable role isto stabilize the spine. [Key words: biomechanics, coactivation, lumbar ‘pine, muscles, stability] Spine 1998;23:86-92 ‘There are a redundant number of strategies that can be used to activate the muscles of the trunk to achieve a desired task. The greatest difference between the activa tion strategy predicted by biomechanical models and that measured by electromyography (EMG) is that, in the models, the degree of coactivation of synergistic and yom the Deparament of Onhopaedics and Rehabilitation, Univarty cof Vermont, Burlington, Vermont. Supported in pase by the ROT AR 44119 grace feom the Nasional Iniutes of Healt Acknowledgment date: August 5, 1996. Firs revision dates January 23, 1997, ‘Acceptance dace: April 16, 1997. Devise status category: 1 86 antagonistic muscles is underestimated.202>24 Sosa Saar 902 ‘This apparently suboptimal and excessive use of mus- cle forces increases lumbar spine loads.®"722") Thelen et al“? estimated that the level of coactivation measured in EMG studies inczeases compressive load on the spine in extension efforts by 16-19% and by a greater amount in lateral bending efforts. For dynamic extension, the cal- culated increase in compressive load is greater, and the estimated shear forces increased by 70% because of this coactivation.!” Hughes et al"? calculated that the in- crease in spinal compression resulting from abdominal muscle coactivation could be as much as 5.52. times as much as the force increase in the abdominal muscles. Biomechanical models are used to identify specific lift ing tasks that may produce low back pain.’ Therefore, ‘models that underestimate muscle coactivation also un- derestimate in vivo spinal and muscular loadings. Besides simple mechanical overload, low back pain could be tiated by damage produced when muscles are not prop- erly activated to maintain equilibrium and stability at all spinal levels. ‘The coactivation of abdominal muscles in extension efforts is associated with increases in intra-abdominal pressure, which in turn generates an extension moment. However, the flexion moment resulting from the muscle forces almost cancels our this effect, casting doubt on this possible advantage of antagonistic abdominal muscle ac- tivity It appears that the only rational reason that coactiva- tion occurs is to stabilize the trunk against the possible destabilizing effects of an unexpected perturba- tion247-184 Anticipatory activation of trunk muscles is apparently an example of simultaneous activation of synergistic and antagonistic muscles used to stabilize the spine" Although coactivation has been attributed qualitatively to a need to increase the spinal stability, this hhas not been shown quantitatively. Stability is used in this report to mean the tendency of a structure to retutn 10 its equilibrium position after a perturbation." Spinal and muscle forces can be studied in two ways: in analytical models to calculate muscle forces required to perform a specified task, and FMG experiments to document the i vivo activities of the muscles. Electro- myogcapbic-assisted models combine both approach- s.78252729 The crunk has a redundant number of mus-Abdominal Muscle Coactivation and Spinal Stability * Gardner-Morse and Stokes 87 cles compared with the minimum number required to achieve a specific task. Analytical models are used to calculate an optimized activation strategy by assuming that the neuromuscular control system activates muscles ‘to minimize a presumed physiologic cost function. Sev- eral such cost functions have been proposed: the com- pressive component of the intervertebral joint force, the shear component, muscle stress, or an exponential func- tion of muscle stress.*!619202%.3458 However, models with these presumed physiologic cost functions do not adequately predict antagonistic activity. Recently, biomechanical analyses have been devel- oped to quantify the stabilizing efecr of muscle forces and muscle stifiness. Bergmark introduced the idea that muscle stiffness, which increases with activation, must exceed a critical value to prevent spinal buckling. Crisco?“ used similar buckling analyses to investigare the relative roles of short and long muscles in stabilizing the spine. Gardner-Morse et al” used a more anatomi- cally realistic model to examine the roles of varying pos- ‘ure and spinal stiffness on spinal stability, and the asso- ciated buckling mode shapes. These models did not include antagonistic muscle activation. Cholewicki and McGill” investigated spinal stability with an EMG- assisted model, which included any muscle coactivation, present in the recorded EMG signals, but the additional contribution to spinal stability of the coactivation was, not determined. Because muscle stifiness increases with activation, the authors of this report hypothesize that the neuromuscu- Jar control system sets the muscle activation and coacti- vation to ensure lumbar spine stability.**!"* This would reduce the need for active neuromuscular control system responses and their inherent time delays. ‘The purpose of this study was to quantify the effects ‘onspinal stability of forcing abdominal muscle coactiva- tion in extension and lateral bending efforts. A previ ‘ously published, anatomically realistic biomechanical model of the lumbar spine and its musculature was sed 490 1 Methods Analyses of spinal stability were performed using a three dimensional biomechanical, quasistatic model ofthe lumbar spine and its musculature."* The geometry was specified in ‘terms of vertebral body positions, locations of muscle aitach- ‘ments, and physiologic cross-sectional areas of muscle. ‘The dorsal muscles, abdominal wall muscles, and psoas, muscles were represented by 50 symmetzic muscle pairs. Ori gins, insertions, and physiologic cross-sectional area of dorsal siuscles and the psoas were obtained from the publications of Bopdak ea. The sume geometric infomation was inferred for the quadratus lumborum from serial, computed tomogra- phy, sectional data published by Han et al.'* For the internal and external obliques, area values were obtained from Han et al,}¥ and the muscle paths were obtained from Dumas et al.!> ‘Three simplifying assumptions were made about all the ‘muscles: 1) muscles were assumed to take a straight-line path from origin to insertion, 2) muscle contractile stress (force! ‘uscle area) was assumed to be between zero (muscles produce ‘only tension) and an upper limit of 460 kPa, and 3) activated ruseles were considered to have stiffness proportional to the level of activation and inversely proportional to muscle length En opal main agent er rena by bea le ‘ents matched to experimentally derived linear stiffness da~ ta."* The thorax and sacrum/pelvis were considered to be rigid bodies, and the sacrum/pelvis was constrained. A static, verti- cal, compressive load of 340 Nwas imposed 50 mm anterior to ‘T12 to represent upper-body weight. In preliminary step, the magnitudes of maximum eforts were calculated by solving the muscle force distibution in a linear program, in which the extemal effort was the cost func- tion to be maximized, as described by Stokes and Garénes- ‘Mosse in a previous stuly.*® Subsequent analyses simulated 2 ‘person performing with submeximmum (40%, 60% and 80%) effors. In the analyses of submaximum efforts, the sum of cubed muscle stresses (0) Was minimized as the objective function for solving the muscle force distribution. This objective is thought to be related to the endurance ofan activity or rate of ‘muscle fatigue; minimizing it would minimize the overall mus- cle fatigue rate.”* This cost function also has been found to zesult in daca that are the most similar to experimental data for spinal muscle activities, 229789" For maximum efforts, the solutions were constrained to sat- isfy sratic equilbrinm of each vertebra, physiologic limits on usc forces, and physiologic mits on motion segment trans- lations and rotations ($ mm and 5° for the sagittal plane and 2 sm and 2° for the other planes, respectively)” For submaxi- mum forts the constraints of intervertebral motions were reduced by scaling them according to the percent effort, be- ‘cause this was considered more realistic. All the optimization calculations were performed using MINOS (Technical Report SOL83-20, Systems Optimization Laboratory, Stanford Uni- versity, Stanford, CA). ‘The linear lumbar spine stability analysis used the muscle and motion-segment forces from the muscle force distribution {optimization analysis. The stability analyses involved the de- termination of the critical amoune of muscle stiffness required to stabilize the spine under the prevailing loading. Mascles have negligible amounts of stifiess when not acti- vated, but activation increases muscle stifiness. 12 Thie si ness is 2 complex function of activation, length, and rate of shortening or lengthening, Itwas assumed i this study that che stability ofthe lumbar spine (for small perturbations) depended om the short-range or cross-bridge muscle stifiess represented. by the linear formulation of Bergmark: here ky represents muscle stifiness (Nara), T represents ac- tive muscle force (N) found in the muscle force distribution analysis, [represents muscle length (mm), and q is a dimen- sionless parameter that is assumed to be the same forall mus- cles, ‘There is « wide range of published values for the muscle stifiness parameter g.1 In the analyses inthe current study, q ‘was treated as a variable, which allowed for the determination,88_ Spine + Volume 23 + Number 1 + 1998 of the lowest (critical) value of g required to ensure stability of ‘he loading state predicted by the force distribution analysis {ive, the value of g that produces a metastable spine). Increases in the value of the critical q represent decreases in stability, because more muscle stifiness is requied to stabilize the spin. Determination of che degree of muscle stifnes critical fr sa- bility required an iterative solution of an eigenvalue buckling analysis ofthe lambar spine stably. The eigenvalue buckling problem was solved using the QZ algorithm (“eig” routine in Matlab, The MathWorks Inc, Natick MA). Details of this ‘method are given in a previously published report by Gardner- Morse et a.!* Extension (resisting a flexion moment) and lateral bending ‘effort were studied without coactivation and with three differ- ‘eat abdominal muscle coactivation patterns. The antagonistic muscles were forced to be ative by raising the lower bounds on the forces of those muscles, Increasing levels ofthe following three muscle coactivation patterns were studied: 4L.coactivation of internal obliques at 2%, 4%, 6%, and 8% ‘of maximum voluntary contraction (MVC); 2. coactivation of external obliques at 2%, 4%, 6%, and. 8% of MVC; and 3. coactivation of internal and external obliques at 2% and 4% of MVC. ‘These levels of coactivation were based on available values from the literature. Thelen etal reported that approximately 20% of MVC coactivation of internal and external obliques, ‘occurred during maximal exertions in extension and lateral bending. Therefore, a lesser degree of activation was consid- ered for the submaximal efforts analyzed in the current study. Lavender et al" reported negligible coactivation of excernal obliques for smal extension efforts and approximately 10% of MVC values in lateral bending efforts. Seroussi and Pope”? reported increasing coactivation of external obliques with in- cxeasing efort in a seves of expeciments, in which participants lifted a weight requiring extension and lateral bending efors m Results Results were quantified in terms of the sum of cubed muscle stresses (30,), which is considered to be a mea- sure of muscle fatigue rate, the maximum compressive loading of the six motion segments (T12-L1 through L5-S1), and the critical value of the muscle stiffness pa- rameter q required for the spine to be stable. Table 1 and Figure 1 show the results for extension efforts, and Table 2 and Figure 2 show the results for lateral bending ef- forts. Tables 1 and 2 give the values for four differing per- centages of maximum efforts with no coactivation. For extension and for lateral bending efforts, spinal stability decreased with increasing effort up to the maximum ef- forts (increasing values of muscle stiffness required for stability). This decrease probably resulted from the spi- nal stiffness, which is independent of efort in these anal- yses, becoming less important relative to the zequired contribution from muscle stiffness. In fact, no muscle stifiness was required to stabilize the spine (q = 0) for Table 1. Values of Critical g, Maximum Spine Compression, and the Sum of Cubed Muscle Stresses {So,,°) for 40, 60, 80, and 100% of Maximum Extension Eforts With No Coactivation Maxima Spite Cam- Boj? (muscle Cita pression targue rate) % Gfor 4 oO (Nim? o 2 028 8 a6 053 a 19 13 100 1 3am 6% and 8% of MVC coactivation of external oblique at 40% of maximum extension effort. Figures 1 and 2 show the percentage changes from the ‘no coactivation” values for the three different coactiva~ tion patterns at 40% and 80% of maximum efforts. The stability increased progressively (smaller values of crit- cal g) in all cases, but at the expense of greater summed 40% Efforts 80% Efforts a6 5 Ob1 Coactvation a oa 4 a (6) Bot OBI. Coacavation )%eB6t obt Coastvation Figure 1. Percent changes trom the no coactivetio values (Tabla 1) inthe erical muscle sifness parameter {oo}, maximum spine compression, (A-++=A) and the sum of cubed musela stresses (elated (0 muscle fatigue rate; (reL) for 40% (e-c} and 80% (4-1) of maximum extensian forts with increasing 2b- ominal muscle caactivasons. In (there was no feesble solution forthe muscle foree ditibution for coactivaion at 8% of ma ‘num voluntary contactor, apparonty because the magnitude of flexion moment produced by the external ebliques overpowered the extensor muscles