Académique Documents
Professionnel Documents
Culture Documents
By Arthur Jones
Chairman, Medex, Inc.
The following pages contain
an advance look at four chapters
from an important new book,
The Lumbar, The Neck and The Knee
Lun1bar FunctiOn
Lumbar function is not what it But with a living subject, very little
appears to be. Not what it is gener- in the way of lumbar rotation can
ally believed to be. Hundreds of be produced without damage to
books and thousands of articles the spine.
have been published on the subject The muscles, ligaments and
of lumbar function; yet many of the facets of the lumbar are designed
generally accepted opinions are for four interrelated purposes ...
wrong, and some are dangerously one, to move the lumbar vertebra
wrong. in the direction of extension ..
In some respects, lumbar func- two, to prevent lumbar rotation .. .
tion is quite simple ... but in other three, to prevent lumbar flexion .. .
ways it is very complex. The prim- four, to limit lateral bending.
ary purpose of the lumbar is to Meaningful measurements of
move the torso in relation to the lumbar function can be produced
pelvis; but for all practical pur- in only one way ... by isolating
poses, such movement is limited to and anchoring the pelvis; if the
extension ... the normal lumbar pelvis is free to move, then any
spine cannot rotate and cannot attempt to measure lumbar func-
flex, cannot move forward beyond tion is doomed to failure. Instead
a straight alignment of the of testing lumbar function you will
vertebra. unavoidably be measuring some
The shape and interlocking rela- unknown combination of hip func-
tionship of the spinal facets pre- tion and lumbar function. Confus-
vent longitudinal rotation from the ing the strength of the hip and
sacrum through T11. The lowest thigh muscles with the strength of
seven vertebra and the sacrum are the lumbar muscles. And confusing
locked together by the facets in hip movement with lumbar
such a manner that rotation is movement.
nearly impossible without damage The muscles of the buttocks and
to the bones. thighs can move the pelvis with
Published reports of vertebral enormous levels of force, rotating
rotation in the lumbar are usually the pelvis around the heads of the
wrong; probably resulting from a femurs ... and any such move-
failure to notice that the pelvis was ment of the pelvis will produce an
moving during the attempts to equal degree of movement of the
measure lumbar spinal rotation. lumbar, since L5 is connected to
Perhaps resulting from conducting the sacrum. Thus lumbar move-
such tests with cadavers, where ment can and does occur even
lumbar rotation can be forced if the when the lumbar muscles are
applied forces are high enough. totally relaxed.
Meaningful measurements of
lumbar function cannot be pro-
duced during either of the two dis-
tinct types of movement illustrated
in the above examples. The first
example does not involve lumbar
function ... and the second exam-
ple involves compound rotation
and compound muscular contrac-
tions that confuse hip function with
lumbar function. In either case,
even if the test results are accurate,
they tell you nothing about lumbar
strength or lumbar range of
movement.
In fact, hyper-extension reduces the perspective changes as a ver- vertebra, probably will not be; but
the force on the rear face of the tebra moves from one position to this matters not at all ... because
discs ... but it is dangerous. another. Thus we have no fixed the relationship of such a line to
Dangerous for another reason reference point on or in the verte- the rest of the vertebra will be a
... dangerous because it imposes bra that maintains its position constant in any position. Thus we
enormous levels of force on the without a change in perspective as know that any change in the posi-
facets. movement occurs. tion of this line is indicative of an
Since it is impossible to establish If we had a straight line scribed equal change in the vertebra.
the exact positions of either the top onto the side of the vertebra, a line
or the bottom of a particular verte- ' that would show up on an x-ray,
bra ... and since the front face of then the required reference point
a vertebra is not a straight line, is would be provided. But since this
generally concave in the center, it is not the case, we must establish
is also very difficult to measure an equally reliable reference point
range of movement by attempting in another manner, in a practical
to compare the front face of a ver- manner ... and we can.
tebra in one position to the same In an x-ray, the only part of aver-
front face in another position ... tebra that maintains the same
difficult, at least, until the problem perspective in all positions is the
is approached in the following front face ... coincidentally, but
manner. fortunately for our purposes, the
Many books and articles have front face of the vertebra is also the
suggested Jl wide variety of clearest and sharpest part of the
methods for accurately measuring vertebral picture; this being true for
the relative movements of the lum- two reasons ... because the rear
bar vertebra ... none of which face of the vertebra is confused
methods are very accurate ... with the facets, and because both
some of which are meaningless. the top and bottom of the vertebra
But it can be done with great are confused because an x-ray
accuracy ... if the following provides a picture of both the near FIGURE 6: Scribing a thin, straight line
procedure is understood and side and the far side of the on the x-ray picture in the manner illus-
applied. vertebra. trated here ... a different line on the
The primary problem with Thus the front face provides the front of each vertebra ... will provide an
attempts to measure vertebral clearest picture; the problem being almost perfect source of reference points
movement results from the lack of that the face is not a straight line. for establishing the angular relationships
a fixed reference point ... we can But such a line can be estab- of the five lumbar vertebra in any posi-
never be sure of the exact position lished; by scribing a perfectly tion from a straight spine to a fully
extended spine.
of either the top or the bottom of a straight and very narrow line on
These lines will tell you nothing about
vertebra, the corners of the verte- the x-ray picture, a line that barely changes in disc space that occur as a
bra are too irregular in shape for touches both of the two most for- result of rotational movement ... but
accurate comparison, and the front ward bumps on the front face of they will provide an almost perfect
surface (the face) of a vertebra is the vertebra. Such a line may not method for measuring the movement of
seldom a straight line. Additionally, be parallel with the midline of the each of the five lumbar vertebra.
f---------i--1 1
FLEXED
[Straight]
FIGURE 7: Having established this FIGURE 8: Our second scribed line, FIGURE 9: A comparison of these two
scribed line on the front face of the perpendicular to the first line, indicates drawings should make the previous
sacrum, you now have a means of meas- changes in disc space that result from points very clear. In this illustration the
uring angular changes between L5 and movement. Tells us whether the spaces front distance increased while the rear
the sacrum. By comparing changes are increasing or decreasing ... and distance decreased ... making it obvious
between the six lines in several positions tells us the location of these changes in that the disc space was opening in front
it then becomes possible to determine any given position. while closing in the rear.
the exact angular movement of the lum- It does not provide a measurement of
bar vertebra in relation to each other and disc space ... but it does clearly indi-
in relation to the sacrum. Total range of cate either an increase or a decrease in
movement can then be determined with disc space.
a very high degree of accuracy ... and Which, for our purposes, is all that we
of even greater importance, it is then require. An accurate measurement of
possible to determine exactly how much disc space would be convenient, but is
movement occurs between adjacent ver- not required.
tebra. Even when the total range of lum-
bar movement appears to be normal, it
does not follow that all five vertebra are
rotating in proper proportion ... or even
that any movement is occurring between
some of the adjacent vertebra.
The greatest
lumbar spine
length occurs
in maximum D
extension
D
both in the front and in the rear.
When this occurs, then it is
7"0
obvious that we have an entirely
different situation ... but the solu-
tion in such cases is not so
D
obvious; now we must deal with
geometrical relationships and
mathematical calculations that are
required for the purposes of
D
-~;
determining the location of the axis
of rotation and the relationship EXTENDED LORDOSIS FLEXED
between the disc spaces on the
front and rear faces of the vertebra.
Which is possible but seldom FIGURE 11: If a point is marked between the bottom of L5 and the sacrum, and
necessary. another point on the top of L 1 .. and if the straight-line distance is measured
between these points ... then it will be shown that the longest distance occurs when
Such relocation of the axis the spine is extended, the shortest distance in a position of lordosis, with an
points of rotation produces other intermediate distance when the spine is flexed.
results as well ... results that have The extended spine is not a great deal longer than the straight spine, but is a lot
nothing to do with the length of the longer than the spine with a lordotic curve. This surprising increase in spine length
lumbar, but have a great deal to do between the lordotic position and the extended position occurs because the axis
with the strength of the lumbar. points of rotation are relocated to the rear; rotation occurs around points well
In the flexed position, when the behind the vertebra, axis points located In the facets. The result being that the
spine is straight, the axis points of vertebra are pulled apart to such an extent that the overall, straight-line length of the
rotation are located somewhere lumbar spine is Increased to a marked degree.
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FIGURE 12: A comaprison of these two actual input of muscular force. The Moving the axis to the rear and down- wrong direction. But in the extended
drawings will clearly demonstrate the measurable output of functional strength wards reduced the horizontal moment- position of the spine, the muscles are no
changes in both leverage and muscular is thus twice as high as the actual level of arm {horizontal in a standing subject) longer pulling in exactly the right direc-
efficiency that result from movement in muscular strength. But only in that posi- while increasing the vertical moment- tion .. a meaningful percentage of the
the direction of extension of the lumbar tion; then, as movement occurs towards arm ... the result being that the initial force produced by the muscles is wasted
vertebra. extension, things change. advantage in leverage is reversed; the because it is being exerted in a less
When the lumbar spine is straight, in When the lumbar spine is extended to muscles are then provided with a disad- advantageous direction.
the flexed position, the muscles are pro- its limit of travel toward the rear, the axis vantage of leverage. In that position, the Both of these factors, changes in the
vided with an advantage of leverage; the of rotation has moved .. has moved a measurable output of funclional strength axis of rotation and changes in the direc-
input of force by some of the muscles is relatively great distance, and has moved will be less than the actual strength of tion of pull of the muscles, combine their
provided at a point far to the rear of the in two directions. Has moved back and the muscles. effects to produce a gross reduction in
axis of rotation ... while the output of down; is now located far to the rear of Secondly ... when the spine is straight, your functional strength as you extend
force is produced at a point much closer the vertebra, in the facets ... to the rear the muscles are pulling in exactly the your lumbar spine.
.... to the axis. Meaning that the output of of its initial location and below its initial proper direction, so none of the muscu-
"' force will be at least twice as great as the position. lar force is wasted by pulling in the
ADVERTISEMENT
.....
111111---lOO lbs. =Input Force minus Friction J/t Compression .force
.n on Knee 1731bs .
...0
0
N
...-
120 lbs.
Input of Force
FIGURE 13: This drawing provides a lower leg is still100 pounds ... but it is Would be if that was the only factor,
simple example of the factors involved in pulling in the wrong direction; is pulling which it is not; additionally, we have
the mechanical disadvantage existing in at an angle that is less than 12 degrees another problem above the patella, a
the knee joint. The knee probably being away from the midline of the lower-leg problem I have not mentioned yet, a
the least efficient major joint in the body. bone . . . which means that at least situation not illustrated In the above
If a force of 120 pounds is produced by eighty percent of the force is being drawing.
the quadriceps muscles, illustrated by wasted, does not serve to move the All of the above assumes that the out-
the hanging weight in this drawing ... lower leg, tries to reciprocate the lower put of force from the quadriceps muscle
then only 100 pounds of that force will leg rather than rotate the lower leg. is pulling against the top of the patella in
be exerted on the top of the patella, The lower leg cannot reciprocate, can exactly the right direction .. which it is
because 20 pounds of that force will be only rotate in one direction ... so the not; instead, a meaningful percentage of
wasted by the internal muscular friction usable force in that position is less than the force produced by the muscle is pull-
within the muscle. twenty percent of the force being exerted. ing in the wrong direction, is thus wasted.
The remaining 100 pounds of force Which is bad enough ... but it gets The complex nature of the quadriceps
will then be redirected around the axis of worse, for two reasons. The output of muscles makes it impossible to accur-
the knee by the patella . . and then force is measured farther down the lower ately measure this loss of force resulting
transmitted by the patellar ligament to leg, at a distance that is approximately from a less than perfect direction of pull
the lower leg. twice as far below the axis of the knee as ... but it would be reasonable to assume
Will be pulling on the bone of the the effective point of attachment of the that at least 20 percent of the force actu-
lower leg at a point that is only a short patellar ligament ... which serves to cut ally produced by the muscle is wasted
distance below the axis of rotation of the the output of function.al strength in half. by this factor; which means that we must
knee ... but the point of attachment to Reducing the output of measurable force add 25 percent to make up for the lost
the lower-leg bone is not the effective to only 10 pounds. force, or must subtract 20 percent as an
point of attachment; the effective point Which means that the input of force by additional loss from the output of func-
of attachment is actually located a rela- the muscle of 120 pounds has been tional force.
tively much greater distance below the reduced to an output of only 10 pounds Meaning that the actual output of
axis of the knee. by the time it reaches a point a foot measurable functional force in the above
Effectively, the point of attachment is below the axis of the knee ... the point example would be only 8 pounds ... an
located where the extended line of pull at which strength is measured, in foot- input of 120 pounds by the muscle but
of the patellar ligament intersects the pounds of torque. an output of only 8 pounds at twelve
midline of the bone; which serves to Since the foot is located even farther Inches below the axis of the knee, or an
improve the situation considerably ... a below the knee, this means that the func- output of only a bit more than 5 pounds if
situation that badly needs improvement, tional strength has been reduced even measured at the foot.
a situation that is still very poor even more at" that point ... if the foot is 18 All of which applies only during a
with this help. inches below the axis of the knee, then dynamic situation, when the muscle is
At that effective point of attachment, the output of force at the foot would be contracting and the lower leg is moving
the force pulling on the bone of the only six and two-thirds pounds. towards extension; because there is no
loss of strength from friction during a be exactly midway between the positive A recently published article on
static test of strength. In a static situa- and negative levels of strength ... the subject of the proper style of
tion, when the muscle was producing because the static level of strength is the lifting reached the correct conclu-
the same force but the lower leg was not actual level of strength, unbiased by fric-
sion, but for the wrong reason; the
moving, then the measured output of tion within the muscle. While positive
functional strength would be about 20
author suggested lifting with a lor-
strength is reduced by muscular friction
percent higher than indicated above. and negative strength is increased by dotic curve, rather than a pelvic tilt.
Or, in a dynamic test of negative muscular friction. His reason being that the muscles
strength ... then the measured output Because of the many factors outlined of the lumbar are strongest in lor-
of functional force would be 40 percent above, the quadriceps muscles are dosis, and thus less likely to be
higher than that produced during a test required to produce enormous levels of injured ... a statement that is
of positive dynamic strength; because force in order to produce an output of partly true and partly false. In fact,
the friction in the muscle helps you dur- functional strength that is required for the lumbar is not stronger in a lor-
ing negative work. Hurts you during pos- even normal activities; a very strong dotic curve ... but is less likely to
itive work, helps you to the same degree man, in order to produce a measured
be injured if lifting is done in the
during negative work, but neither helps output of 600 foot-pounds of torque with
nor hurts during static efforts. his quadriceps muscles, and some few
manner suggested. Lordosis being
Friction in a muscle? men can ... is thus required to produce safer because the muscles are not
Yes ... everything in nature produces a force in excess of 7,000 pounds of pull- stretched to their limits, and if for-
friction, if it is moving, and a muscle ing force with his quadriceps muscles; ward movement is forced then the
must produce internal movement in order which exposes his knees and femurs to muscles are capable of such
to contract. an even higher level of force, a far higher movement without being injured.
Even light produces friction ... and level of force ... 73 percent higher if his This author stated that recent
the power in an average car is reduced I legs are bent 120 degrees at the time this tests of the actual strength of the
approximately 70 percent by friction. So force is produced ... but only a little lumbar muscles had proven that
don't be surprised that a slowly contract- over 40 percent Jf the legs are bent 90
ing muscle loses about 16 percent of its
these muscles are actually far
degrees ... and only about 9 percent if
force due to friction. That is not a high the legs are bent 66 degrees. stronger than was previously
degree of friction; on the contrary is a This increase in compression forces believed. But the facts are that he
very efficient situation. on the knees and other parts of the body has never seen, nor even heard of,
Movement of anything produces fric- results from the fact that the structure of any tool of any sort that was capa-
tion ... and, once moving as a result of the legs above and below the knees ble of producing measurements of
an applied force, an object will then creates a block and tackle situation when lumbar strength. The only equip-
accelerate until the friction produced by the legs are bent at the knees. Meaning ment in the world that is capable of
movement is equal to the applied force. that a force of 7,000 pounds produced making such measurements in any-
Then how can Cybex Corporation by the quadriceps will be increased to a thing even approaching a meaning-
claim that a higher level of functional level of compression force on the knees
ful manner is not yet available to
force (strength) can be produced in a in excess of 12,110 pounds if the legs are
dynamic test than the force measured in bent 120 degrees at the time. anybody outside a limited number
a static test? But if the legs are straightened to a of researchers.
Because they are not measuring func- point where they are only 66 degrees Equipment that is capable of
tional strength ... instead are measur- short of full extension, then this magni- measuring lumbar strength with an
ing the high and dangerous levels of fication of compression forces is reduced
accuracy approaching 100 percent
impact forces produced when the sub- to only 9 percent ... when fully extended,
ject crashes into the resistance pad. straight, the magnification of force is
now exists ... but nothing on the
Impact forces that distort and magnify zero. subject of this equipment was pub-
the actual force produced by the muscle Yet many doctors and therapists are lished prior to August of 1987, and
by several hundred percent. Levels of still telling people with knee injuries to thus was not available to this
functional force that cannot be produced avoid exercise within the last twenty or author.
by the muscles, but that are imposed on thirty degrees of extension ... under the Published and advertised claims
the joints of the subject by impact load- totally mistaken impression that work- made on behalf of isokinetic
ing. Try pushing against a boulder with ing in that area of movement imposes methods of attempting to measure
you foot, and then kick it as hard as pos- high levels of compression forces on the lumbar strength are utterly ridicu-
sible. You will actually produce more knee; when, in fact, quite the opposite is
lous ... would perhaps be amus-
functional force while pushing, but will true. Which should be obvious, since the
be exposed to far higher and very dan-
ing if they were not being accepted
required mathematics is at about a third-
gerous forces when kicking. grade, grammar-school level, and the by some people who remain
If your positive strength, your lifting required physics at about a first year of unaware of the facts ... and if the
strength, is 100 ... then your static high school level; unless they have suggested methodology of testing
strength will be 120, and your negative changed the laws of physics and the was at least safe.
strength will be 140; these ratios befng rules of math since I learned them more But the facts are that the results
true only during tests performed at rela- than half a century ago, or perhaps some of all such tests are worse than
tively low speeds during the dynamic people fail to realize that physiology worthless, worse because they are
tests ... greater differences being pro- simply means the physics of biology. grossly misleading ... and the
duced at higher speeds because the fric- Now you should also realize just why
method employed for conducting
tion in the muscle is increased at higher knee problems are so common, and why
speeds. things like jump squats are so danger-
such tests is dangerous to an
But regardless of the speed, and ous; and why the lumbar spine Is so extreme degree. Danger to no pur-
regardless of the level of either strength much more efficient than the knees. pose. Danger with no slightest
or fatigue, the static strength will always chance of worthwhile return.
I. i
mine the strength of the lumbar
muscles have failed because, until I ; 1 I ~j_-----( ! 1
~ - - - ~-- - ~1 -- - ----1-------bll;;+i
recently, it was simply impossible
to test the strength of these mus-
cles in total isolation. Total isola-
tion of the lumbar muscles, and
thus the possibility of accurate
15
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measurement of lumbar strength,
was first made possible less than
109 .... 1--..... ' ... ... I ., I'
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two years ago ... but not in a prac-
tical manner. ... l _.------_..-. ~ --~----...L______/ I I I
The machine that first made
such accurate testing possible was
huge, very complex, uncomfortable
s 0---~r:~:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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for a healthy subject and all but
impossible to use with an injured iI. l
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subject, and intimidating for any Q L. . . . . . . . . . . . .L.. . . . . . . . . . . . J. . . . . . . . . . . . . . J.. . . . . . . . . . . .J. . . . . . . . . . . . . J. . . . . . . . . . . . . . .!i. . . . . . . . . . . . . . i.. . . . . . . . . . . . . ..l. . . . . . . . . . . . .J
subject ... but it did, at least, pro-
vide the first source of accurate
0 10 20 39 48 50 60 70 30 90
measurement of lumbar function. It Angle in Degpees
was capable of producing accurate FIGURE 15: This chart illustrates two bar problems and totally asymptomatic.
tests of lumbar function, and strength tests of a subject with a pre- A later series of three lateral x-ray pic-
nothing else was, but it certainly viously unsuspected lumbar problem. tures with the lumbar flexed, lordotic
was not practical for anything The higher of the two curves is a full- and extended produced no additional
more than very limited use in a range test of his fresh strength, while the evidence of pathology; but with or with-
research environment. But that lower curve is a full-range test of his out such additional evidence, this sub-
momentary strength immediately follow- ject has a serious problem in his lumbar
situation now has changed. ing an exercise for the lumbar-extension . .. almost certainly a problem related to
The key to accurate testing of muscles. Thus this chart represents both the soft tissue.
any muscle is isolation, which in pre-exercise and post-exercise lumbar A follow-up series of CAT-scans and
many cases is impossible; fortu- strength. Lumbar strength tested In total magnetic resonance examinations is
nately, in the case of the lumbar isolation, with no slightest involvement scheduled but the results of these tests
muscles, the required degree of of other muscles. are not yet available. But again, with or
isolation did prove to be possible. The differences in these two test without such additional evidence, this
Not simple, but possible; we results are an accurate measurement of subject has a problem; a problem that
worked on this situation for more the effect of the exercise, the immediate was immediately identified by a proper
than fourteen years before we even consequences of the exercise, the testing procedure of lumbar function.
momentary reduction in strength result- Apart from the marked dip in strength
understood the problems that had ing from the exercise. This degree of that occurred in a position about thirty-
to be solved. Providing practical effect was produced by exercising for three degrees short of full extension,
solutions for these problems took thirteen repetitions with a resistance of this subject's lumbar strength curve was
an additional amount of time and 150 foot-pounds. normal; but such a dip in strength is not
an enormous amount of work. The subject is a white male, 31 years of normal, is clearly indicative of a prob-
While you may or may not be age, five feet ten inches tall and weigh- lem. A problem that would not have been
interested in exactly how and why ing 160 pounds; with no history of lum- identified by a dynamic test.
Fol:"ce in lh:s:.
. ................................... !'"""""""""'"""!
NOTE . . The charts on this page were accidently reversed by the printer,
when reading the caption for figure 25, look at figure 26, and when reading
the caption for figure 26, look at figure 25. . -~- _________ , 1