Vous êtes sur la page 1sur 18

ADVERTISEMENT

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.

42 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT

FIGURE 1: A comparison of these two


figures gives a clear illustration of back
extension that does not involve lumbar
function. Lumbar movement, but not
lumbar function ... the lumbar vertebra
maintained the same relative positions
to one another and to the sacrum
throughout the movement, and the
muscles of the lumbar maintained the
same length throughout the movement.

FIGURE 2: These figures show the type


of compound movement that is usually
involved in trunk extension; movement
of the pelvis produced by the muscles of
the hips and thighs ... with simultane-
ous movement of the lumbar vertebra in
relation to the pelvis produced by the
lumbar-extension muscles.

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.

. FIGURE 3: The figures to the left illustrate.


lumbar function in total isolation; the
lumbar vertebra rotate to the rear In rela-
tion to the sacrum, but the pelvis does
not move .. must not move If you are
attempting to measure either the range
of movement or strength of the lumbar.

RISKS & BENEFITS MANAGEMENT, Oct 1987 43


ADVERTISEMENT
Anchoring the pelvis in order to axis is difficult to locate. the front while reducing it in the
isolate the lumbar is only the first During that part of the move- rear ... but this does not occur.
of more than a dozen absolute ment, the axis points are between Instead ... extension much
requirements for meaningful mea- the vertebra ... so any movement beyond a point of normal lordotic
surements of lumbar function ... in the direction of extension will curve increases the disc space
but many of the additional increase the disc space in the front both front and rear. Because the
requirements will be covered in a while reducing the disc space in axis points of rotation move to the
following chapter, so I will limit my the rear. rear ... move a long way to the
remarks in this chapter to points The disc spaces, front and rear, rear. Extension much beyond a
that must be mentioned for a clear are approximately equal only when normal lordotic curve involves rota-
understanding of lumbar function. the lumbar spine is in the flexed tion around axis points that are
Meaningful lumbar function is position (straight). well behind the rear face of the
limited to extension ... rotation In the normal position of lumbar lumbar vertebra.
towards the rear; rotation occur- lordosis, the disc space is Hyper-extension has been a buzz
ring simultaneously around five increased in the front and reduced word in the field of medicine for at
distinct points ... between L5 and in the rear. least fifty years that I am aware
the sacrum, and below each of the If the axis points of rotation of ... it having been generally
other four lumbar vertebra. A nor- remained in their original posi- assumed that hyper-extension was
mal range of movement will usually tions, then continued movement to dangerous because it squeezed the
be between about 60 degrees of the rear from a lordotic position discs between the rear edges of the
rota~ion and 75 degrees of rotation. would increase the disc space in vertebra.
Much less than 60 degrees is
indicative of pathology ... and
anything in excess of 75 degrees is
abnormal.
If all of the five joints are free to
move in an unrestricted manner,
then the average movement will
range from a low of about 12
degrees per joint to a high of about
15 degrees per joint.
It is generally believed that an
extreme degree of extension, so-
called hyper-extension, produces
AXIS

compression forces on the lumbar
discs by reducing the vertical dis-
tance between the vertebra along
the rear faces of the vertebra ...
thus compressing the discs. Quite
the opposite is true.
Rather than compressing the
discs in the rear, hyper-extension LORDOSIS FLEXED
actually increases the disc space
along the rear face of the lumbar FIGURE 4: A comparison of these two comparing the top of a vertebra in one
vertebra ... instead of increasing figures demonstrates what occurs in the position to the top of the same vertebra
the forces on the discs, hyper- disc space as you move from a flexed in another position.
extension reduces the force on the position towards a lordotic curve. The And very difficult to measure the
discs. But it is dangerous ... not disc space increases in front while changes that occur in the disc space as a
decreasing in the rear. Which relative result of movement.
dangerous to the discs but to the
changes in disc space mean that the axis But even without the ability to mea-
facets. of rotation is somewhere between the sure these changes in disc space with
Because ... the axis points of front and rear surfaces of the vertebra great accuracy, a comparison of any two
rotation of the lumbar vertebra ... to the rear of the front surface, to the of the lumbar vertebra in a flexed posi-
change as extension occurs. front of the rear surface. tion to the same two vertebra in a posi-
Extension much past lordosis If the profile view of a vertebra was a tion of lordosis will make it obvious that
moves the axis far to the rear, into perfect rectangle with square edges, the front disc space has opened while
the facets. then it would be possible to determine the rear disc space has closed.
During movement in the direc- the exact axis of rotation ... but the It has generally been assumed that
tion of extension ... starting from irregular shape of the vertebra makes continued extension beyond a position
this very difficult. of normal lordosis would open the front
the flexed position, and ending in
X-rays, CAT -scans and magnetic space even wider, which in fact is what
the position of normal lordosis ... resonance illustrations all suffer from a happens ... but it has also been assumed
the axis of rotation of each of the common problem ... it is impossible to that such continued extension would
involved joints is located to the determine the precise surface of either reduce the rear disc space even more,
rear of the front face of the verte- the top or the bottom of a vertebra. Thus and this does not happen. Instead, exten-
bra, and to the front of the rear it is impossible to accurately measure sion much past lordosis opens the disc
face of the vertebra. But the exact the range of rotational movement by space both in the front and in the rear.

44 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT
FIGURE 5: Extension much beyond a
position of normal lordosis opens the
disc space both in the front and in the
rear .. because the axis of rotation has
moved, is no longer between the verte-
bra, is relocated to a position behind the
rear face of the vertebra.
Thus the initial movement, from a
straight spine to a lordotic curve, Involves
AXIS rotation around an axis located between
the vertebra ... while continued move-
-=====r-----------~ ment much to the rear of a lordotic curve
involves rotation around an axis located
behind the vertebra, an axis located in
the facets.

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.

RISKS & BENEFITS MANAGEMENT, Oct 1987 45


ADVERTISEMENT
Which leads to the next problem Having established those six It would be convenient for our
... attempting to establish the rela- lines, you can then measure angu- purposes if this second line could
tive positions of L5 and the lar changes in vertebral position be positioned at the precise mid-
sacrum, and the changes that ... but you still have no means for point of the vertebra, exactly mid-
occur as movement occurs. measuring changes in disc space way between the top and the bot-
X-ray pictures of the sacrum, in a ... nor do you have a means for tom of the vertebra ... would be
lateral view, are never as clear as locating the axis points of rotation. convenient, but is not possible, is
the front faces of the vertebra ... But this can also be done ... not possible because we cannot
because the sacrum is confused and again with a very high degree determine the midline of the verte-
and blurred by the near side of the of accuracy. bra ... would be convenient, but is
pelvis. But again fortunately for our Pick a point along the line on the not necessary for our purposes. All
purposes, the front face of the front face of each of the five verte- that is required is that this second
sacrum has rather distinct bumps bra and on the sacrum ... an arbi- line is perpendicular to the first line
that show up as points in a lateral trary point, but a point that is and that it has an exact length ...
x-ray picture. Select any two of below the top of the vertebra and
these bumps that are shown on all above the bottom of the vertebra
of your x-ray pictures and scribe a ... then scribe a second thin line
line that barely touches the most on the x-ray picture; a line that is
forward points on these bumps. perpendicular to the first line (90
degrees out of phase, a perfect
right angle in relation to the first
line) ... and a line that is exactly
one inch long, or exactly 25 mil-
limeters long, or any otherexact
length so long as this line does not
extend as far as the rear face of the
vertebra.
The length of this second line is
unimportant, provided it is not too LORDOSIS
long, and is always the same
length in all cases.
Nor is the vertical positioning of
this line important ... so long as it
is not above the top of the vertebra
or below the bottom of the
vertebra. ~T~~
~=:::::~~ 1. 97

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.

46 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT
almost any length, but always the
same length.
It is also helpful if a short line is
added at the far end of this second
line ... a short line perpendicular
to this second line; which serves as
a clear mark indicating the end of
this line.
In order to measure disc space, it
would be necessary to establish
the exact top of one vertebra and
the exact bottom of the adjacent
vertebra, and this is not possible
because of the problems inherent
in x-ray pictures.
But it is possible to establish that
changes in disc space are occur-
ring with movement, and where
such changes are occurring, and EXTENDED LORDOSIS
whether the changes produce an FIGURE 10: Continued movement past a lordotic position, in the direction of exten-
increase or a decrease in disc sion, will eventually produce an increase in disc space both in the front and in the
space. rear ... and it also produces another result, a rather surprising result; the overall
But this will not always happen length of the spine changes during extension, changes in both directions ... first
... sometimes the vertical distance becomes shorter than the length in the straight starting position, then becomes
between the two lines will increase longer. The greatest overall length of the lumbar spine occurs in a position of
maximum extension.

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.

RISKS & BENEFITS MANAGEMENT, Oct 1987 47


ADVERTISEMENT
and perhaps as much as 400 imposed upon his knees was some-
pounds. thing in excess of 10,000 pounds in
The extremely complicated some positions.
interrelationship of the lumbar Which is why your femurs are so
facets and the lumbar extension strongly constructed ... they must
muscles is such that it is simply be strong in order to withstand the
impossible to measure this forces produced by the quadriceps
mechanical advantage with any- and magnified by the angle of pull
thing even approaching a high in some positions.
level of accuracy ... but it is Which is also why knee problems
obvious that such a mechanical are so common.
advantage exists. The knee is probably the least
Which is fortunate indeed, liter- efficient major joint in the body ...
ally essential for lumbar function; and the lumbar section of the spine
because the lumbar muscles them- contains some of the most efficient
selves are rather small, and rela- major joints in the body. If the
tively weak. Without this enormous situation were reversed then you
mechanical advantage, the lumbar would be built like the Hunchback
muscles would have to be many of Notre Dame but with the thighs
times as large as they actually are of a flamingo.
... in which case the size of the In a position of lumbar flexion,
required muscles would be so the muscles of the lumbar are at
great that they would limit the least twenty-five times as efficient
range of possibl e lumbar
1
as the quadriceps of the thighs ...
movement. 1
perhaps as much as fifty times as
A similar situation exists in the efficient.
neck muscles of a rhino, but with- But that advantage of leverage
out the mechanical advantage exists only when the spine is
found in the human lumbar; the straight ... then, as the vertebra
The lumbar result being the huge lump of mus- move to the rear during lumbar
cle located above the shoulders of extension, things change. Two
section of the a rhino, an enormous mass of
muscle that is required because
changes occur simultaneously;
both of which changes produce
spine contains the necessary degree of mechani-
cal advantage is not provided in
losses in functional strength.
One ... the axis of rotation
some of the their cervical vertebra.
An extreme example of a
moves towards the rear, thereby
reducing the previously-existing
mechanical disadvantage is found advantage in leverage. Two ... the
most efficient in the human knee; where more angle of pull of the muscles is
than 90 percent of the muscular changed as the facets rotate
major joints force is wasted ... the result being downwards, thereby reducing the
that only about eight percent, or effective strength of the muscles.
less, of the force produced by the A large part of the mechanical
quadriceps muscle is actually advantage is lost, even reversed,
between the vertebra ... but the usable for the purpose of extend- and the muscles are no longer pull-
input of muscular force is pulling ing the lower leg around the axis of ing in exactly the proper direction;
at a point that is far to the rear of the knee. the net result being a great loss in
the axis ... and the input of force Additionally, because of the rela- functional strength.
is parallel to the possible direction tive angles of pull in some posi- But even in their worst position,
of movement. The muscles are tions, the compression forces on having lost the mechanical advan-
wasting none of their force by pull- the knee during leg extension are tage and with the muscles no
ing in the wrong direction ... and, far higher than the level of force longer pulling in the proper direc-
secondly, the muscles are provided being produced by the quadriceps. tion, the muscles involved in lum-
with an enormous mechanical In one instance that I will cover bar extension are still far more effi-
advantage. in more detail in a later chapter, cient than the quadriceps muscles.
In that position, the muscles are one of our research subjects was An efficiency provided by the
provided with at least a two-to-one capable of producing an accurately bony structure of the lumbar, not
mechanical advantage ... in some tested output of 654 foot-pounds of by the strength of the lumbar mus-
cases perhaps as much as a four- torque in the leg-extension move- cles. The vertebra and their related
to-one advantage. Meaning that ment ... and in order to produce facets are simply a masterpiece of
the extension muscles of the lum- such an output of force his quad- structural engineering; in compari-
bar, in that position, may produce riceps muscles were required to son, the knee is an outrage.
a pulling force of only 100 pounds produce at least 7,350 pounds of The more I study the lumbar, the
while producing an output of func- pulling force. Which also means more impressed I become by its
tional force of at least 200 pounds, .that the compression force design.

48 RISKS & BENEFITS MANAGEMENT, Oct 1987


:D

...iii
(/)
go
til
m
z
m
'11
:::j
(/)

~
>
z
>
C)
m
~
m
VERTICAL


z
.:-t
0
~
MOMENT
~

:> AXIS
.._,
CD

VERTICAL
MOMENT

)>
c
<
m
HORIZONTAL :xJ
::!
MOMENT en
m
s:
..----1 m
z
-1
HORIZONTAL
MOMENT

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

I 10 lbs. Slow Dynamic Test


output of force
or, 121bs. Static Test
output 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

50 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT

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.

RISKS & BENEFITS MANAGEMENT, Oct 1987 51


ADVERTISEMENT
FIGURE 14: A measurement of the out- Fo'!'ce: l hs.
put of force (torque) that is produced by
a maximal muscular contraction can be 4.0Q r. . . . . . . . . . . ,. . . . . . . . . . . . . .~. . . . . . . . . ,. . r-.. . . . . . . .,r..,. . . . . . . . .T .............., ........r. . . . . . . . . r. . . . . . . . . .,. .,. ,. . . . . . . . . . l
very misleading if you fail to consider ; I ! I I I
I i
l I
I ___. .. - l~
I
the involvement of at least one important
factor ... the joint system of the body,
and thus the advantage or disadvantage :!< ,-;;...... ~
- ... ~
II
i
J! Ii li
. _,...--
.~
l
-~
i
l
of leverage that a muscle must use in """ ~ ' j_
l I
"'"""'"'''1"""""''"""""'"''~""''~~:.>~"""'i"''"'""'"""''"'"''l"''""''""'"''"''""i """""""'''"'""''"'l
,

~.. I _ _ l _ _ le::l::~J.,~J:::.=~L_ _ _l. -----1'


performing work.
When comparing the relative strength
of the lumbar-extension muscles, for
example, to the leg-extension muscles, 2
the quadriceps ... it might appear that
-!-- L "L-~~-t1 ~
' _.,
~/ l
il
I
~
the lumbar muscles are nearly as strong I J ~ ~ ' =~~-- 1 4 ~ ~
as the big muscles of the thigh; when in
fact nothing could be further from the ~ _-0 1 -l~~-~ t-~-r~ I I l I I
truth.
The lumbar muscles are perhaps the
most efficient muscles in the body; but
~ ~ l~----l------T--r--r- r--l-----T----r--1
still are not very big, and thus are not
I ~ ! ~ 1 ! i ! ~
really very strong. Meaning ... the mus-
cle itself cannot produce an actually
0 l. ~ .,,.,..,i,,,,,,,,,,,,,..,,J.. ,,,,,............ .J. . . . ,.,,,,,,,,,,,,,,l,,,_,,,,,,,,,, .J. . . . . ,,,. . . . .,.J. . .,,,,,,,,,,,,_.l
high level of force. Only appears to do so Q 19 2~ 30 4'-l 50 60 ?9 8@ 9@
because of an advantage of leverage. Angl eo in Degrees
But remember, ten pounds of force will
lift a ton .... if you use a long enough must stop testing before we reach that thirteen repetitions while using resis-
lever. Will not lift it very far, but will lift it. point in the movement. tance of 200 foot-pounds, and by con-
Also remember that the lumbar muscles We perform exercise in the last few tinuing the exercise until additional
are not required to move the vertebra of degrees of the range of movement, but movement was momentarily impossible.
the lumbar very far, while the thigh mus- we cannot test there with a meaningful Meaning that when he failed, his
cles must move the lower legs a rela- result. remaining strength was slightly below
tively much greater distance. Also note that there are two curves on the level of resistance.
So don't make the mistake of trying to the chart; the highest curve being an This degree of effect, a thirty-one per-
compare the lifting strength of two men accurate measurement of the strength cent loss in strength, is on the high side
... one of whom is using a long crowbar of the fresh muscles; the second, lower for good results. Better results will gen-
and one of whom is not. Which is similar curve being a measurement of the lum- erally be produced when the degree of
to what you are doing when you com- bar strength immediately after an exer- effect of exercise is limited to about
pare the measured output of the lumbar cise for these muscles. So these are pre- twenty percent ... at least fifteen per-
to that of the thighs. exercise and post-exercise tests ... the cent and not more than twenty-five
Also note that the peak of strength difference being an accurate measure- percent.
was not produced in the position of ment of the effect of the exercise, the But such a degree of effect cannot be
normal lordosis, as incorrectly stated in immediate consequences of the exer- produced by guesswork; tests such as
the previously mentioned article; rather, cise .. clearly showing just how much this, however, will clearly tell you just
the peak of strength was in the starting his strength was momentarily reduced how much resistance, and how many
position, when the lumbar spine was by the exercise, and where it was repetitions with that resistance, are
straight. By the time the subject had reduced. required for the desired degree of effect
moved back to a position of normal lor- The average loss of strength through- from exercise.
dosis, the level of strength had declined out the tested range of movement was This subject, as judged by this test
by about a third from its level in the start- approximately thirty-one percent ... this result, requires a somewhat higher level
ing position ... a very meaningful drop being based upon the change in the of resistance . . . which higher resis-
in strength, not an increase as stated in areas under the curves. This subject tance will automatically produce the
the article. produced this effect by exercising for desired degree of effect very accurately.
The right side of this chart shows
strength in the forward position, when
the lumbar spine is straight ... the left
hen proper exercise for the
side of the chart shows strength in the
fully-extended position, when the spine
is bent to the rear.
W lumbar muscles is performed,
and when it is proper in every
bar function is usually involved in
back extension ... usually, but not
always ... it is also true that back
Such a test can be started at the limits sense, it is not only very safe but extension is largely a result of the
of the front position, but must be stopped very productive; and rapid muscles that move the pelvis in
short of the fully-extended position; increases in strength will be pro- relation to the legs, primarily the
because the output of force in the duced ... but very little in the way muscles of the buttocks and the
extreme rear position will always be zero of exercise is actually required to thigh-biceps muscles.
. . in that position there can be no
produce good results, and more Until and unless these muscles
measurable output. Regardless of how
weak or how strong you are, your meas-
will seldom produce better results, are totally removed from the equa-
urable output of force will always be will usually produce less results. tion, it is simply impossible to
zero at the limit of the possible range of Confusing back-extension with measure the strength of the lumbar
movement produced by muscular force. lumbar function has created a muscles. The muscles of the but-
And since a reading of zero gives us great deal of misunderstanding. tocks, working with the thigh-
nothing for comparison to later tests, we While it is certainly true that lum- biceps muscles, move the pelvis in

52 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT
relation to the legs ... and such something works, or why some- resolved ... so do not make the
movement is usually a part of back thing does not work, in this mistake of skimming over the fol-
extension; but this movement has instance it is very important-to lowing chapters, perhaps under the
absolutely nothing to do with lum- understand both the problems and impression that technical details
bar function ... in fact, this move- the solutions to those problems; are of no practical value. While it
ment is usually the source of the thus, in more than one sense of the may be true that the safe use of a
problem in the first place. Damage term, this book largely consists of car does not require the knowledge
to the lumbar muscles is usually a a how-to manual ... how to test necessary for building a car, in
.result of the forces produced by the lumbar, how to rehabilitate at dealing with lumbar problems you
these other, larger and far least some of the common lumbar must understand both the prob-
stronger, muscles ... and when a problems, and how to design and lems and the solutions ... the
very high level of force is produced build a meaningful testing machine methods detailed for meaningful
by these muscles, a high level of for the lumbar. testing of lumbar function that are
force that exceeds the limits of the Without such an understanding, described in later sections of this
structural integrity of the lumbar some people will be left in doubt book are not merely one of the
muscles, then an injury becomes a and many of the mistakes of the best methods for this purpose, they
certain result. past will be repeated; but given the are quite simply the only method
The strength of the lumbar mus- information in the following chap- for meaningful testing. There is no
cles is not very great ... in fact, ters, such doubts should be other way.
the lumbar muscles are the weak
link in the system. J:l'or>ce: l b:s:,
All previous attempts to deter- 20~ !". . . . . . . . . . . . . i. . . . . . . . . . . . . . r. . . . . . . . . . . . . .r. . . . . . . . . . . I . . . . . . . . . . . . . . . . . ". . . . . . . . !.
r ...........................l'. . . . . . . . . . . . . .
!, .......................... ~

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
Q
! . .., ~ .
- - +-----
l
-1
II
1===" ~=. :;.,-w:;:f::7(........ ~~:~~:/"""'"'l"'"""""'""""'"l""'""''"""''"'""''
j::::~:::7'~:. . .1
measurement of lumbar strength,
was first made possible less than
109 .... 1--..... ' ... ... I ., I'
"''"""""""'""'""'f""""""""""""'''j
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:~:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i ,
l. . . . . . . . .
~ ~
J. . . . . . . . . . l . . . . . . . . . . . . .~ . . . . .
j.. . . . . . . . . . . . . . or ...

~
!
for a healthy subject and all but
impossible to use with an injured iI. l
~
I
l
1
lI
!~ I
:
n
Il .! ~
.i
I
1
' j i ~ j !
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.

RISKS & BENEFITS MANAGEMENT, Oct 1987 53


ADVERTISEMENT

Fol:"ce in lh:s:.
. ................................... !'"""""""""'"""!

energy and his own inability to produce


a perfectly smooth movement.
Which figures are conservative, be-
cause these figures were based on this
published chart rather than the raw data,
and this chart shows its force curves on
a gross scale.
5 Thus the actual variation in the forces
was even less than shown ... ideally will
be, and can be, less than one percent.
Compared to the wildly varying levels
of force produced in any sort of isokin-
etic testing or exercise machine, the
level of resistance provided by this
1Q 80 90 machine is almost perfect; a near per-
fectly controlled level of force produced
FIGURE 16: This chart shows the forces At the point where the desired level of by the fact that eighty-seven and one-
produced during a dynamic test of the resistance was rxactly 100 pounds, the half percent of the kinetic energy has
same subject. The speed of movement total variation in actual force was only been engineered out of this machine ...
varied from a high of about 80 degrees five and one half pounds ... meaning making it possible to move at relatively
per second during the first repetition to a that the force imposed in that position fast speeds without suffering the conse-
low of below 20 degrees per second dur- was never more than two and three- quences of wildly varying force levels
ing the final repetition. Resistance pro- quarters percent above or below the and high levels of impact forces that are
vided during the entire range of move- desired level of force. unavoidable in isokinetic machines.
ment of 72 degrees was 150 foot-pounds; Since the friction in this machine adds This subject experienced no pain or
with which resistance this subject was about one percent to the resistance dur- discomfort during either of the two static
able to perform 13 repetitions before ing the lifting part of the movement while strength tests and was able to conduct
failing. subtracting about one percent from the the dynamic test with no pain or discom-
There are a total of twenty-six force resistance during the lowering part of fort; but if he had been tested only in a
lines on this chart; one line for each of the movement, this means that this sub- dynamic fashion then there would have
the thirteen positive (lifting) movements ject produced an additional variation of been no indication of his strength-curve
and one line for each of the thirteen neg- force of only about one and three- abnormality, and thus his lumbar prob-
ative (lowering) movements. quarters percent as a result of kinetic lem would have been overlooked.

FIGURE 17: This chart represents the


lumbar test results of a retired physician,
70 years of age, a white male of five
feet and six inches weighing approxi-
mately 150 pounds; this subject was
born with an abnormal lumbar spine, LS
being located to the front of a normal
position in relation to the sacrum ... but
in proper relation to the other lumbar
vertebra. These abnormalities are clearly
shown in following illustrations.
In this instance, the subject is asymp-
tomatic at present but did have lumbar
pain many years earlier. His strength
level is normal for his size and age but
his strength curve is abnormal in two
respects; in the starting position of the
tests, when his spine was flexed, he
should have been somewhat stronger
... instead of rising or remaining con-
stant, his strength should have declined
as extension occurred. Secondly, later
in the range of movement, his strength
showed a slight dip at one point; nothing
on the order of the drop in strength dis-
played by the other subject, but a dip in
strength that should not have occurred.

54 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT

FIGURES 18, 19, & 20: The genetic


abnormality of this subject's spine pro-
duced a limited range of movement in
the direction of lumbar flexion and even-
tually resulted in lumbar pain; a condi-
tion that might have been detected much
earlier had it then been possible to con-
duct meaningful tests of lumbar function.

RISKS & BENEFITS MANAGEMENT, Oct 1987 55


ADVERTISEMENT
FIGURE 21: The above chart compares
the results of two tests of isolated lum-
bar strength throughout a full range of
normal movement. The higher curve
representing the fresh strength of the
lumbar-extension muscles prior to an
exercise for these muscles. The lower
curve representing the lumbar strength
immediately after the exercise. The dif-
ferences between these two recorded
levels of strength being the effect of the
exercise, the immediate consequence of
the exercise.
Both curves are perfectly normal,
indicating proportionate and appropriate
levels of strength in every position.
But other important information is
provided by these tests as well; one, the
level of strength is well above average
for a subject of this age, size and pre-
vious exercise experience ... two, this is
obviously a Type S subject, meaning
that he responds to exercise in a specific the exercise, the immediate consequence in order to know his strength ... because,
manner, will produce results only in of the exercise, being based upon the once the ratio of strength to anaerobic
positions where exercise is performed, changes produced in the areas under endurance is established, then later
this being obvious bedause of the rela- the curves. measurements of anaerobic endurance
tionship of his strength in his strongest This tells us several things. Tells us will also tell us his strength, since
position to that in his weakest position that he has an average distribution of strength and anaerobic endurance go
... three, this subject shows a mixture of fiber types in his lumbar muscles. Tells up and down together.
fiber types in his lumbar muscles, this us that he should exercise with the level Future increases in his anaerobic
determination being based upon the of resistance used during this test, endurance will clearly tell us that his
magnitude of effect produced by the because the degree of effect was appro- strength has increased in exact propor-
exercise. priate for producing good results from tion. Which adds to the safety of later
Nine repetitions of a full-range exer- exercise. Tells us the existing ratio tests, because tests of anaerobic endur-
cise for the totally isolated lumbar mus- between his strength and his anaerobic ance can be conducted at lower levels of
cles produced a momentary reduction in endurance; which means that we will force. And the lower the level of force,
strength of 20.28 percent; this effect of never again have to measure his strength the higher the level of safety.

FIGURE 22: This chart shows the pre-


exercise and post-exercise strength tests
of totally isolated lumbar-extension
muscles in a different type of subject ...
a different fiber type.
This subject produced an effect, a
temporary loss of strength, of nearly 57
percent from an exercise performed for
ten repetitions using 100 foot-pounds of
resistance. Nearly three times the degree
of effect produced by the previous
subject.
Which is far too high a degree of effect
for good results from exercise. Best
results from exercise will generally be
produced by an effect somewhere
between 15 and 25 percent. -
Which means that this subject must be
exercised very carefully ... not too much
and not too often. Which also means that
he has an unusually high percentage of
so-called fast-twitch muscle fibers ...
close to 100 percent from the results of
this test. Meaning that he has a very high The shape of his strength curve, the subjects are Type S (specific), while
potential for strength in these muscles, ratio of strength in his strongest position about 18 percent of the subjects that we
but will never have much endurance. to that in his weakest position, tells us have tested proved to be Type G
Since his tested strength level was that he is a Type G subject ... meaning (general).
only average, this means that he has per- that he will respond to limited-range So we have a good example of a typi-
formed little if anything in the way of activity in an overall manner. Will pro- cal Type G subject with an unusually
meaningful exercise for these muscles; duce full-range strength increases even high percentage of fast-twitch muscle
because, given this type of muscle from limited-range exercise ... which is fibers. Compare this subject's test results
fibers, he has great potential for lumbar a decided advantage since most activi- to the following chart.
strength. ties are limited-range in nature. Most

56 RISKS & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT
FIGURE 23: This chart presents the pre-
exercise and post-exercise test results Fox>ce: l bs.
of totally isolated lumbar strength in a 409 r-....................,.........._...........,...,_............,.......- ............, .. ~-~--r-- . . . . . . . . . . . . . . . . . . . .T. -..............."{............ ~ .....1
subject who is different from the preced- i l ~ 1 ~ 1 ~ l l
ing subject in two important ways.
' I
1
! I
'
l
I, l
1
!
I
~
l
This is a TypeS subject ... his strength
in his weakest position is far lower as a 3S0 .---t-- L.- j __ j_J . . . J...- . . . f...-. +---1
I !! l. Il
percent of his strength in his strongest
! I I !I I
r--r--
position, by comparison to the earlier !
subject. In their strongest positions, the -I I !
strength of these two subjects was almost
exactly the same; but in the weakest
positions; the Type G subject was more
200
-~--- b~~j~-~~~1.-. -~-. r--~~~;
than twice as strong as the other subject. l 1 .-
...-.
1 .... -.:::l---- !
..- . n
!
I
i!
In fact, the situation was even more
radical ... because their range of possi-
ble movement was not the same in the
direction of extension. The Type G sub-
ject was far more flexible, demonstrated
a greater range of movement towards
extension.
0 ............-.. . -.L...........- .....
9 10 2 9
t. . . . . . .L~
31ll 40 59 ?0 8 Ed 99
60
I. . . . . . .
L .................._L. . . . . . . . . . . .
....- ........ J ..... _........J. . _._,_, ........J

If the Type S subject had an equal Angle in De~:r~:ees


degree of flexibility, then his strength in
the extended end of the movement would subject. Later, when given a somewhat higher
have been even lower than shown her~. In this case, the higher of the two level of resistance, this subject did con-
So a true comparison of strength in the strength curves is not the pre-exercise tinue the exercise to a point of momen-
extended positions would be about a test; instead, it is the post-exercise test. tary failure; but even then the degree of
three to one ratio ... meaning that the The exercise did nothing to reduce this effect was very low. His strength was
Type G was three times as strong in that subject's starting level of strength, actu- reduced by only about two percent from
position although no stronger in a flexed ally increased the starting level of its starting level.
position. strength. Such a subject will never be very
Which comparison demonstrates the During the test we gave this subject a strong in his lumbar muscles, but will
importance of correlating accurate level of resistance that was a bit too low display an almost unbelievable level of
measurements of position with measure- and he proceeded to perform a seem- anaerobic endurance.
ments of strength. A. test of peak strength ingly endless number of repetitions; But the important thing to realize Is
with these two subjects would have indi- eventually I told him to stop, since the that a style of exercise that is actually
cated an equality in strength when in resistance was obviously too low, and required by this subject would be utterly
fact that is not a true picture. then we tested his post-exercise strength devastating for the other type of subject.
But there is another difference of far immediately. With the results shown; his This subject requires high-repetition
greater importance; this subject proba- strength had increased throughout the exercise; the other subject cannot toler-
bly has almost 100 percent slow-twitch full range of possible movement, in- ate high-repetition exercise, would
fibers in his lumbar muscles, the oppo- creased by 10.31 percent based upon rapidly lose strength if worked in that
site type of fiber shown by the earlier the areas under the curves. manner.

recovering from the effects of the exer-


cise ... which tells us a great deal about
his recovery ability, and thus his toler-
ance for exercise.
In this case, after nearly three hours,
the subject had recovered just over
sixty-six percent of the loss in strength
produced by the exercise; which is a
very slow rate of recovery, and does not
mean that he will be totally recovered
within another two or three hours.
Initial recovery is very rapid, and in
most cases a normal subject will recover
fifty percent of the lost strength within
about thirty minutes; but then it will take
him another twenty-four hours or more
to recover completely.
When the degree of recovery shown
here is factored by the time required to
produce it, this means that total recov-
ery will require at least two days, and
FIGURE 24: This chart shows three minutes after the post-exercise test; a probably three days. If this subject, or
strength tests with the Type G subject recovery test. any subject, is exercised again before
shown earlier. The same two pre-exercise This third test is performed and com- total recovery has been produced, then
and post-exercise tests and a third test, a pared to the other two tests in order to the result will be a loss in strength rather
iest performed two hours and forty-six determine just how quickly the subject is than a gain.

RISKS & BENEFITS MANAGEMENT, Oct 1987 57


ADVERTISEMENT
pre-exercise test of fresh strength ...
but since no such dip occurred in the
post-exercise test, then it is almost cer-
tain Jhat the slight dip r~tsulted because
this subject really did not try quite as
hard as possible in that one position dur-
ing the initial test.
Which could have been confirmed or
refuted by asking him to repeat the pre-
exercise test prior to any exercise. If
such a shape in the tested strength curve
is indicative of an actual decline in
strength in that position, then it will
repeat itself in two tests performed a few
minutes apart with no exercise between.
Assuming only that the subject cooper-
ates in both tests.
An exception to this general rule
occurs with subjects that have an unus-
ually high percentage of fast-twitch
muscle fibers; such subjects will display
a much lower level of strength in a
FIGURE 25: This chart shows the pre- was slightly on the high side for best second test, even without exercise
exercise and post-exercise tests of results but this can be corrected by between the two tests, because they
another subject with an average distri- adding a small amount of resistance. suffer from fatigue as a consequence of
bution of fiber types. Another Type S Range of movement was unrestricted their fiber types. But even then, while the
subject with an average level of strength in either direction, the total range of tested levels of strength will be different
for his age, size and previous history of possible movement being 73 degrees. with such subjects, the shape of the
exercise. The only thing not quite right is the strength curves will not change and any
!he degree of effect from the exercise fact that a very slight dip occurredin the abnormality in shape will repeat itself.

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

loss in strength rather than an increase.


Such a subject should never be exer-
cised more than twice a week, and may
produce better results on a schedule of
only once a week.
But such comparisons tell us other
things of enormous value ... clearly
spell out just what type of work this sub-
ject can handle without risk of injury;
and of perhaps greater importance, the
type of work he should avoid.
This subject is very strong in his
lumbar-extension muscles, but has very
little endurance ... can easily and safely
handle heavy lifting, if such work is not
repeated too often ... but must not per-
form work that requires either frequent
or continuous lifting. Not even frequent
lifting of a relatively light weight.
A high percentage of injuries to the
soft tissue of the lumbar area are caused
by fatigue; but a fatigued muscle does
FIGURE 26: This chart combines the The relatively flat strength curve in his not lose its structural integrity, remains
pre-exercise and post-exercise strength- fresh muscles also tells us that he is a as structurally strong as it was when
test results of totally isolated lumbar- Type G subject, will produce full-range rested ... that isn't the problem. What
extension muscles in a subject with an results even from limited-range activity happens is that fatigue causes the worker
unusually high percentage of fast-twitch or exercise; his strength in his strongest to change his style of lifting, and that
muscle fibers. An effects test, showing position was only about twice the level in change in procedure is what causes the
the immediate consequence of the his weakest position. A Type S subject injury; either from the addition of force
exercise. would show a much greater loss of produced by jerking instead of lifting, or
This subject produced this effect as a strength in the extended positions. from lifting in an unusual posture. A
consequence of only six repetitions with Such an effect, a momentary loss of position that imposes the force in an
a resistance of 200 foot-pounds ... a strength exceeding nine percent PE!r area of the body that cannot tolerate the
momentary reduction in his starting level repetition, is far too much for good load.
of strength of just under 55 percent. A results from exercise; if trained in this Based upon his demonstrated level of
very deep effect. manner too often, the result would be a lumbar-extension strength, far above

58 RISK & BENEFITS MANAGEMENT, Oct 1987


ADVERTISEMENT
average ... it might appear that the
above subject was ideally suited to a job
that involved lifting; while, in fact, quite
the opposite is true.
Given that level of lumbar strength,
and given an entirely different type of
muscle fiber, then he would be suited for
such work. But such a combination is
rare, this being a classic example of an
either/or situation; you can have a strong
back as a result of your fiber type, or you
can have great endurance in your lum-
bar muscles, but not both. Most people
are neither; instead show a mixture of
fiber types that preclude great strength
but give them a reasonable level of
endurance.
Employed in a position that involved
frequent lifting, even rather light lifting,
the above subject would fatigue very
rapidly. Then in order to continue work-
ing he would be forced to change his
style of lifting, thereby greatly increas-
ing the chance of injury.
f'nother subject mentioned earlier, the
su,bject with an abnormal level of endur-
ance, would be ideal for such employ-
ment; while less than half as strong as
this subject, he could work continuously
with little or no sign of fatigue. Would
not be forced by fatigue to change his
style of lifting, and would thus be far less
likely to sustain an injury. While nowhere
near as strong as this subject, the man
with the endurance type muscle fibers in B y the end of this year, 1987, we
should have completed accur-
ate lumbar testing on a total of at
number of unavoidable conclu-
sions ... the evidence is simply
overwhelming; even though a few
his lumbar muscles has a far higher level
of work capacity. least 30,000 subjects; which test of these conclusions are direct refu-
Given the requirement to lift a weight results will be published in a sup- tations of beliefs that some people
of 50 pounds once every two minutes, plement to this book to be pre- simply take for granted.
the stronger of these two subjects might pared in December of 1987 and But in one sense at least, it was
be flat on his face within an hour or two; published in time to be distributed probably an unavoidable situation,
while the weaker of the two could work simultaneously with the publication certainly an understandable situa-
ten or twelve hours in an almost non-
of this book in late January of 1988. tion ... because, before meaning-
slop fashion, and might be stronger at
the end of the day than he was at the
These tes'ts are being conducted ful testing became a reality, all.of
start. at the University of Florida School us were guessing, basing our opin-
The strength of both men can be of Medicine in Gainesville and in ions on data that was misleading.
increased by proper exercise, and doing three other locations; under the Lumbar function is very com-
so will increase their anaerobic endur- direct supervision of Dr. Mike Pol- plex, can be tested in a meaningful
ance in direct proportion; but even if lock, past president of the Ameri- manner only under carefully con-
given an increase of fifty percent in his can College of Sports Medicine, trolled circumstances using
endurance, the stronger man would still and other equally qualified people, equipment that provides all of the
have very little ... and given an increase several of whom are orthopedic essential requirements; none of
of fifty percent in his strength, the other
surgeons. During 1988 we intend which requirements were provided
man would still not be very strong.
Both subjects should be exercised,
to conduct at least an additional in any of the previous equipment
and both stand to gain from exercise, 100,000 lumbar tests; all of which intended for this purpose. Most of
and proper exercise for the lumbar mus- will be included in later supple- which requirements cannot be pro-
cles will reduce the chances of injury in ments to this book. vided by any form of isokinetic
both cases ... but it will not change the But it is already apparent from testing machine.
type of muscle fiber they have. the tests that have been conducted Now that we can test lumbar
The implications should be obvious up to date that lumbar function is function accurately and in a mean-
for industry; as a screening test for far different from most previous ingful manner, it is only a matter of
workers, such tests can go a long way in assumptions ... and equally time until many of the presently
the direction of fitting the job to the man. apparent that earlier attempts to misunderstood problems in this
The annual cost of lumbar injuries being
what it now is, even a slight reduction in
measure lumbar function were important area of the body will be
the number of such injuries would meaningless. understood; when we finally do
quJckly justify the costs of conducting We already have an enormous understand the problems, perhaps
tliese tests with all or most of the workers amount of data, and from a careful we will also have a better under-
in many occupations. study of this data have reached a standing of how to deal with them.

RISK & BENEFITS MANAGEMENT, Oct 1987 59

Vous aimerez peut-être aussi