Lumbar loads and trunk kinematics in people with a transtibial amputation during sit-to-stand

Actis, Jason A.; Nolasco, Luis A.; Gates, Deanna H.; Silverman, Anne K.

doi:10.1016/j.jbiomech.2017.12.030

Cited by 29 publications

(23 citation statements)

References 52 publications

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“…In studies that have assessed sagittal plane mechanics of STS in low back pain patients, most only distinguish degrees of motion at the trunk, hip, and knee and are limited with a cross-sectional study design. The few studies that have measured joint kinetics during STS in low back pain patients show linkages between compensatory lower limb biomechanics and relatively higher loads on the spine [ 17 , 24 ]. Our present study uniquely examines STS in ASD patients whose lower limb compensatory biomechanics are likely a compensatory response to poor postural control from spinal malalignment; however, the lower limb compensatory biomechanics could be exacerbating poor outcomes by increasing loads on the spine.…”

Section: Discussionmentioning

confidence: 99%

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

et al. 2019

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Study design A longitudinal cohort study. Objective To define a set of objective biomechanical metrics that are representative of adult spinal deformity (ASD) post-surgical outcomes and that may forecast post-surgical mechanical complications. Summary of background data Current outcomes for ASD surgical planning and post-surgical assessment are limited to static radiographic alignment and patient-reported questionnaires. Little is known about the compensatory biomechanical strategies for stabilizing sagittal balance during functional movements in ASD patients. Methods We collected in-clinic motion data from 15 ASD patients and 10 controls during an unassisted sit-to-stand (STS) functional maneuver. Joint motions were measured using noninvasive 3D depth mapping sensor technology. Mathematical methods were used to attain high-fidelity joint-position tracking for biomechanical modeling. This approach provided reliable measurements for biomechanical behaviors at the spine, hip, and knee. These included peak sagittal vertical axis (SVA) over the course of the STS, as well as forces and muscular moments at various joints. We compared changes in dynamic sagittal balance (DSB) metrics between pre- and post-surgery and then separately compared pre- and post-surgical data to controls. Results Standard radiographic and patient-reported outcomes significantly improved following realignment surgery. From the DSB biomechanical metrics, peak SVA and biomechanical loads and muscular forces on the lower lumbar spine significantly reduced following surgery (− 19 to − 30%, all p < 0.05). In addition, as SVA improved, hip moments decreased (− 28 to − 65%, all p < 0.05) and knee moments increased (+ 7 to + 28%, p < 0.05), indicating changes in lower limb compensatory strategies. After surgery, DSB data approached values from the controls, with some post-surgical metrics becoming statistically equivalent to controls. Conclusions Longitudinal changes in DSB following successful multi-level spinal realignment indicate reduced forces on the lower lumbar spine along with altered lower limb dynamics matching that of controls. Inadequate improvement in DSB may indicate increased risk of post-surgical mechanical failure. Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Electronic supplementary material The online version of this article (10.1007/s00586-019-05925-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

et al. 2019

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“…Humans use homologous (or analogous) limb muscles to conduct StS. Studies have reported StS activity mainly for the equivalents of GSup, GMed, BF, ST, RF, VM, VL and GasM (EMG data: Roebroeck et al, 1994 ; Pandy et al, 1995 ; Khemlani et al, 1999 ; Actis et al, 2018 ) in addition to M. tibialis anterior and M. soleus (e.g., Silva et al, 2013 ; these muscles are not active/present in our simulation) e.g.,. Increased activity occurs if the former muscles if load is added to subjects, whereas other muscles (M. soleus, M. tibialis anterior) do not increase activity.…”

Section: Discussionmentioning

confidence: 99%

“…Savelberg et al ( 2007 ) explained this phenomenon as evidence for a decreased strength:weight ratio in loaded subjects, challenged by StS biomechanical demands that the primary StS muscles satisfied. Furthermore, StS in humans tends to involve marked co-activation of muscles with antagonist (e.g., hip/knee flexor) actions against antigravity muscles, perhaps as to aid in stability (e.g., Roebroeck et al, 1994 ; Khemlani et al, 1999 ; Savelberg et al, 2007 ; de Souza et al, 2011 ; Actis et al, 2018 ; Shia et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…We used static optimization to generate our simulations, which included an objective function that minimized the sum of muscle activations squared (as did Actis et al, 2018 ; for human StS). However, this approach likely generates results that do not exactly match the controls that greyhounds actually use in StS and may explain many disparities in our results vs. other data.…”

Section: Discussionmentioning

confidence: 99%

“…It is widely considered that, because of these demands, the way humans stand up changes during their lifetime from a more demanding pattern (“momentum transfer strategy”) to one that minimizes muscular effort in elderly humans with muscle weakness (“stabilization strategy”) (e.g., Savelberg et al, 2007 ; Van der heijden et al, 2009 ). Hence standing up is constrained by the strength-to-weight ratio in humans in some way, although the specific mechanisms and control strategies used to overcome strength-to-weight limitations during this movement remain controversial (Pandy et al, 1995 ; Bobbert et al, 2016 ; Actis et al, 2018 ; Shia et al, 2018 ), and neurophysiological control mechanisms for StS are still being deciphered (e.g., Silva et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

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Limb Kinematics, Kinetics and Muscle Dynamics During the Sit-to-Stand Transition in Greyhounds

Ellis

Rankin

Hutchinson

2018

Front. Bioeng. Biotechnol.

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Standing up from a prone position is a critical daily activity for animals: failing to do so effectively may cause an injurious fall or increase predation susceptibility. This sit-to-stand behaviour (StS) is biomechanically interesting because it necessitates transitioning through near-maximal joint motion ranges from a crouched (i.e., poor mechanical advantage) to a more upright posture. Such large joint excursions should require large length changes of muscle-tendon units. Here we integrate experimental and musculoskeletal simulation methods to quantify the joint motions, limb forces, and muscle fibre forces, activations and length changes during StS in an extreme athlete—the greyhound—which has large hindlimb muscles bearing short-fibred distal muscles and long tendons. Study results indicate that hindlimb anti-gravity muscle fibres operate near their ~50% limits of length change during StS; mostly by starting at highly lengthened positions. StS also requires high muscle activations (>50%), in part due to non-sagittal motions. Finally, StS movements require passive non-muscular support in the distal hindlimb where short-fibred muscles are incapable of sustaining StS themselves. Non-locomotor behaviours like StS likely impose important trade-offs between muscle fibre force capacity and length changes, as well as active and passive mechanisms of support, that have been neglected in locomotor biomechanics studies.

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Musculoskeletal Health After Blast Injury

Silverman

Hendershot²,

McGregor³

2022

Blast Injury Science and Engineering

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Lumbar loads and trunk kinematics in people with a transtibial amputation during sit-to-stand

Cited by 29 publications

References 52 publications

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

Limb Kinematics, Kinetics and Muscle Dynamics During the Sit-to-Stand Transition in Greyhounds

Musculoskeletal Health After Blast Injury

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