Scribd Logo
Importer

Bienvenue sur Scribd !

  • Role of Muscles in Lumbar Spine Stability in Maximum Extension Efforts

    Transféré par

    Masita Luthfi V P
    4 vues7 pages
    muscles and lumar spine stability

    Copyright

    © © All Rights Reserved

    Formats disponibles

    PDF ou lisez en ligne sur Scribd

    Avez-vous trouvé ce document utile ?

    Ce contenu est-il inapproprié ?

    Signaler ce document
    muscles and lumar spine stability

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    4 vues7 pages

    Role of Muscles in Lumbar Spine Stability in Maximum Extension Efforts

    Transféré par

    Masita Luthfi V P
    muscles and lumar spine stability

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 7
    Seumal of Ory e602 Te eur of se Jl Sugey, 1 G'9%5 Ortop essa Sone) Role of Muscles in Lumbar Spine Stability in Maximum Extension Efforts Mack Gardner-Morse, Ian A. F. Stokes, and “Jeffrey P. Laible Depaviment of Orthopaedics ond Rehabilitation, and "Department of Civ and Environmental Hngincering, University of Vermons, Burlington, Vermont, US.A. ‘Summary: Many problems of the lumbar spine that cause pain ave attributed to instability. The ligamentous spine (without museles) is unstable at very low compressive loads. This study examined the hypothesis that instability of the lumbar spine is prevented under normal cizeumstances by the stiffness of spinal musculature, Without active responses from the neuromuscular control systems. The effect of muscle activity (Corce and stiffness) on the stability of the lumbar spine was analyzed for maximum voluntary extension efforts with di ferent spinal postures in the sagitial plane. The analysis included realistic three-dimensional representation ‘of the muscular snatomy with muscles erossing soveral motion scemonts. ‘The stiffness of motion segments ‘was represented using in vitro measured properties, Under a range of conditions with maximum extension ‘effort, active muscle stiffness was required to prevent the lumbar spine from buckling. The dimensionless valve of the muscle stiffness parameter q as a function of activation and length had to be greater than a critical value in the range of 37-4.7 in order to stabilize the spine. Experimentally determined values of ¢ ranged from 0.5 to 42. These analyses demonstrate how changes in motion segment stiffness, muscle activa tion stratogy, or muscle stiffness (due to degenerative changes, injuries, fatigue, and so on) might lead to spinal instability and “self-injury” In vito, the ligamentous lumbar spine is unstable at compressive loads of 88 N (8); however, in vivo the compressive force acting on the lumbar spine exceeds 2,600 N, as demonstrated by measurements of intea- discal pressure (25) and biomechanical models of lift ing (32). Thus, the spinal column is inherently unstable, but it is believed that in vivo a combination of muscle forces and muscle stifnesses stabilize it. Spinal insta- bility or segmental instability is a concept used clini- cally to describe a situation in which motion segments ‘apparently are hypermobile (10). Although this clini- cal condition is notoriously poorly defined (1), i gen. erally is considered a degenerative condition of the motion segments. Most biomechanical studies have assumed that it is simple overload of the spine that causes injuries (5) and their painful. consequences Therefore, prevention of injury and effective rehabil- itation has been directed primarily at minimizing spi- nal forces. This viewpoint does not take into account that muscles are required to stabilize the ligamentous spine or the possible destabilizing effects of poor new romuscular coordination, Received Apri 2, 1994; acsoptod Decomber 22, 1994 ‘Address correspondence and reprint requess fo M, Gatdnes= Morse at Dopattmant of Orthopedics and Rehabilitation, Stat ford Hall, University of Vermont, Burlington, VT 05405-0084, USA, Muscle and ligamentous forces increase the com- pressive load on the spine, increasing its tendency to buckle; however, the muscle forces are required to stabilizé the spine. The relative magnitude of these competing effects must be resolved with quantitative analyses, If muscles acted as pure force generators, then the nervous system would be responsible for stabilizing the spine by producing an appropriate response to ‘every small disturbance. Instead, it appeats that acti- vated muscles act not only as force generators but also as stabilizing springs (2.6.7). The amount of muscle sfiffiness depends on the degree of muscle activation, soit can be set or modulated in advance under control ‘of the nervous system. This regulation of muscle stiff- ness by activation (and mote commonly coactivation. of antagonist muscles) is used in targeted movements to control the trajectory of a body segment (15). Previous investigations of the stability of the spine started with the observation that the ligamentous spine is highly unstable (8.2133). Bergmark (2) exam- ined the possibility that muscle stiffness stabilizes the Jumbar spine for extension efforts using a model with simplified muscle anatomy and motion segments The distribution of muscle force was reduced to static de- terminacy by a number of simplifying assumptions; however, it was found that the muscle stiffness re- quired for stability was high compared with values 802 ROLE OF MUSCLES IN LUMBAR SPINE STABILITY 803 FIG. 1, Anteroposterior view of the lumber spine model. The Wtergray cylinders represent the lumbar vertebrae, wi rigid connections supporting muss alechmont, Me thera is «gid ‘ody to which all thoracic muscles aach. The postion of SL is Indiated by a simple cylinder The rst of the sacrum and the pelvis which were fixed) ace not shown. Active muscles (activity fniresponcing to the maximum extension effort) are thown ae epiadess with diameters proportional to ther physiologic ctoss- feetional areas, and inactive muscles ae sown a ein ines. subsequently reported by Crisco and Panjabi (6,7 from 2 review of the literature on muséle physiology. This leaves open the question of how muscle stiffness stabilizes the spine. Crisco and Panjabi (7) explored the eritical mascle stiffness required to maintain stability in five differ cnt hypothetical muscle architectures attached to @ straight spine but did not establish how this would apply to realistic anatomy or how the required sti ness might relate o properties of active muscle. Dietsich et al. (2) modeled the musculature of the spine as solid finite elements with linear passive and active stifness. The model buckled, but they did not establish how such buckling is avoided in vivo. Because of the approximations and simplifying as- sumptions in previous studies, it has not been estab Fished quantitatively whether muscle stiffness alone is adequate to stabilize the spine in response to small perturbations. We analyzed stability using realistic data for spinal geometry, motion segment stiffness, and musele anatomy. The overall hypothesis was that damage occurs in the low back when muscles are not sufficiently well coordinated to maintain both equilib- rium and stability at all spinal levels We addressed ‘maximum extension efforts because they are consid- ered more challenging to stability and have unique solutions in the analysis of distributions of muscle fotce. This avoided a major simplifying assumption of previous studies We hypothesized that the lumbar spine normally is stabilized in response to small dis- turbances from the maximum effort state by the stiff ness of spinal musculature. In this way, it would be “self-stabilized” without active responses from the neuromuscular control system, which has inherent time delays. METHODS "The analysis of amber spins stability involved two sequential steps: (a) an analysis of eistibation of msele Tore, whieh i volved ince programming with equilibrium and physiotogc con ‘ents, wa wed to ealulate the nanimum extension effort and corresponding motion segment and muscle foress, and (b) an i fgenvalue bucking analysis of spinal stabilty was done aes, using the motion segment and muscle foees found in the firs step The geometry of the lumbar spine model was specified in teams of vertebral body positions locations of muscle atachment points, and phyeiologe cross sectional areas of muscle (3,34) (Hg. 1). The dorsal musculature, rectus abdominis and psoas were represented by 66symmerie muscle pars The ame thee simplifying seu ns were made about al of the muscles (a) they take a sesght Fine path from origin to inscrtion, (b) their contractile stress (oreefmusee area) was betwoon 0 (uselosprodoce only tension) and 469 kPa (334), and (¢) they have active stifiness proportional te activation and inversely proportional to muscle length (2). The model used beam clement (11) matehed to the experimentally derived data on linear slfiness given by Panjabi etal. 27) to represent the spinal motion segments The thorsx and sacsumipel- vs were oth considered as rg bodies ‘The sacrumipelvs was

    Vous aimerez peut-être aussi