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Mathematical Modelling of Muscle Recruitment And MATHEMATICAL MODELLING OF MUSCLE RECRUITMENT AND FUNCTION IN THE LUMBAR SPINE MICHELLE L GATTON BScHons Submitted for the award of degree of Do ctor of Philosophy in the Centre for Rehabilitation Science and Engineering Scho ol of Mechanical Manufacturing and Medical Engineering Queensland University of Technology September Keywords lumbar spine anatomical mo del spinal mo del lumbar spine muscle moments muscle force iii Abstract Low back pain is an increasing problem in industrialised countries and although it is a ma jor so cioeconomic problem in terms of medical costs and lost pro duc tivity relatively little is known ab out the pro cesses underlying the development of the condition This is in part due to the complex interactions between b one muscle nerves and other soft tissues of the spine and the fact that direct obser vation andor measurementofthehuman spine is not p ossible using noninvasive techniques Biomechanical mo dels have b een used extensively to estimate the forces and mo ments exp erienced by the spine These mo dels provide a means of estimating the internal parameters which can not be measured directly However application of most of the mo dels currently available is restricted to tasks resembling those for which the mo del w as designed due to the simplied representation of the anatomy The aim of this research was to develop a biomechanical mo del to investigate the changes in forces and moments which are induced by muscle injury In order to accurately simulate muscle injuries a detailed quasistatic three dimen sional mo del representing the anatomy of the lumbar spine was develop ed This mo del includes the nine ma jor force generating muscles of the region erector spinae comprising the longissimus thoracis and ilio costalis lumb orum multi dus quadratus lumb orum latissimus dorsi psoas ma jor rectus ab dominis v transverse ab dominis internal oblique and external oblique as well as the thora columbar fascia through whichthetransverse ab dominis and parts of the internal oblique and latissimus dorsi muscles attach to the spine The muscles included in the mo del have been represented using muscle fascicles each having their own force generating characteristics and lines of action Particular attention has b een paid to ensuring the muscle lines of action are anatomically realistic particularly for muscles which have broad attachments eg internal and external obliques muscles which attach to the spine via the thoracolumbar fascia eg transverse ab dominis and muscles whose paths are altered bybony constraints such as the rib cage eg ilio costalis lumb orum pars thoracis and parts of the longissimus thoracis pars thoracis In this endeavour a separate submo del which accounts for the shap e of the torso by mo delling it as a series of ellipses has been develop ed to mo del the lines of action of the oblique muscles Likewise a separate submo del of the thoracolumbar fascia has also been develop ed which accounts for the middle and p osterior layers of the fascia and ensures that the line of action of the p osterior layer is related to the size and shap e of the erector spinae m uscle Published muscle activation data are used to enable the mo del to predict the maximum forces and moments that may be generated by the muscles These predictions are validated against published exp erimental studies rep orting max imum isometric momentsforavariety of exertions The mo del p erforms well for exion extension and lateral bend exertions but underpredicts the axial twist moments that may be develop ed This discrepancy is most likely the result of dierences between the exp erimental metho dology and the mo delled task The application of the mo del is illustrated using examples of muscle injuries created by surgical pro cedures The three examples used represent a p osterior surgical approach to the spine an anterior approach to the spine and unilateral total hip replacement surgery Although the three examples simulate dierent muscle injuries all demonstrate the pro duction of signicant asymmetrical mo ments andor reduced joint compression following surgical intervention This result has implications for patient rehabilitation and the p otential for further injury to the spine The development and application of the mo del has highlighted a number of ar eas where current knowlegde is decient These include muscle activation levels for tasks in p ostures other than upright standing changes in spinal kinematics following surgical pro cedures such as spinal fusion or xation and a general lack of understanding of how the b o dy adjusts to muscle injuries with resp ect to mus cle activation patterns and levels rate of recovery from temp orary injuries and comp ensatory actions by other muscles Thus the comprehensive and innovative anatomical mo del which has b een develop ed not only provides atoolto predict the forces and moments exp erienced by the intervertebral joints of the spine but also highlights areas where further clinical research is required Contents Keywords iii Abstract v Table of Contents ix List of Tables xv List of Figures xix List of Abbreviations xxv Statement of Originality xxvii Acknowledgements xxix Intro duction A Review of Past Mo delling of the Lumbar Spine Electromyographic Mo dels Mo dels by McGill and coworkers Mo dels by Granata and coworkers Cholewicki and McGill whole spine mo del Optimisation Mo dels Choice of ob jective functions Mo dels by Schultz and cow orkers ix Mo dels by Ladin and coworkers Mo dels by Gracovetsky Farfan and coworkers Mo dels by Stokes and GardnerMorse Hybrid mo dels Mo dels using Neural Networks Anatomical Mo dels Concluding Remarks Anatomy and biomechanics of the lumbar spine Muscular anatomyofthe lumbar spine Muscle co ordinate data Physiological crosssectional area Muscle force Lengthtension relationship Active tension Passive tension Kinematics of the lumbar spine Range of motion Movement within the range of motion Instantaneous centres of rotation D mo del of the lumbar spine Mo del Assumptions Co ordinate system Mo del input Upright stance Muscle Activation Mo del structure Change of basis calculations Aligning the spine in the required p osition Muscle lines of action Output moment calculations Metho ds for calculating lines of action for muscles with curvature between origin and insertion Longissimus thoracis pars thoracis Fascicles attac hing to the ribs Psoas ma jor muscle insertion on the femur Ab dominal obliques Torso mo del Bending the torso Application of metho dology TLF Anatomy of the TLF Mo delling the TLF Lines of action for the p osterior layer Lines of action for the middle layer Altering the p osture of the spine Calculation of moments mo del Application of the Results and Validation Comp onents of the mo del Fascicles attaching to the ribs Ab dominal obliques TLF Results from the entire mo del Upright stance Alternative p ostures Validation of the mo del Application of the mo del Posterior lumbar surgery Impairment of ab dominal muscles Total Hip Replacement surgery Conclusion Conclusions and directions for further research APPENDICES A A study to compare PCSA and CSA values for the psoas ma jor muscle B Investigation of spinal kinematics during exion C Co ordinates representing the ribs and vertebrae of the Visible Man C Posterior margin of the lumbar vertebrae C Ribs to D Determining lo cal co ordinate systems and lo cations of the IARs from the spinal anatomy of the Visible Man D Setting up an orthogonal basis on the vertebral body D Basis vectors for the spine of the Visible Man D Determining the lo cation of ICRs E A comparison of techniques for mo delling the oblique muscle lines of action E Discussion F Moments predicted by the TLF mo del G Mo del output for individual muscle fascicles in upright stance H Moments ab out a normal spine in a variety of p ostures I Changes in forces and moments ab out a spine after p osterior surgery Bibliography List of Tables Muscles included in the anatomical mo dels prop osed by various authors
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