Qualitative studies investigating the sexual activity of people with low back pain found a substantial reduction in the frequency of coitus and have shown that pain during coitus due to mechanical factors (i.e., movements and postures) are the primary reason for this decreased frequency. However, a biomechanical analysis of coitus has never been done. The main objective of this study was to describe male and female lumbar spine and hip motion and muscle activation patterns during coitus and compare these motions and muscle activity across five common coital positions. Specifically, lumbar spine and hip motion in the sagittal plane and electromyography signal amplitudes of selected trunk, hip, and thigh muscles were described and compared. A secondary objective was to determine if simulated coitus could be used in place of real coitus for future coitus biomechanics research. Ten healthy males (29.3 ± 6.9 years, 176.5 ± 8.6 centimeters, 84.9 ± 14.5 kilograms) and ten healthy females (29.8 ± 8.0 years, 164.9 ± 3.0 centimeters, 64.2 ± 7.2 kilograms) were included for analysis in this study. These couples had approximately 4.7 ± 3.9 years of sexual experience with each other. This study was a repeated-measures design, where the independent variables, coital position and condition, were varied five (i.e., QUADRUPED1, QUADRUPED2, MISSIONARY1, MISSIONARY2, and SIDELYING) and two (i.e., real and simulated) times, respectively. Recruited participants engaged in coitus in five pre-selected positions (presented in random order) for 20 seconds per position first in a simulated condition, and again in a real condition. Three-dimensional (3D) lumbar spine and hip kinematic data were continuously collected for the duration of each trial by optoelectronic and electromagnetic motion capture systems. Electromyography (EMG) signals were also continuously collected for the duration of each trial. The kinematic data and EMG signals were collected simultaneously for both participants. Five sexual positions were chosen for this study based on the findings of previous literature and a biomechanical rationale. QUADRUPED – rear-entry, female quadruped, male kneeling behind – had two variations; in QUADRUPED1 the female was supporting her upper body with her elbows and in QUADRUPED2 the female was supporting her upper body with her hands. MISSIONARY – front-entry, female supine, male prone on top – also had two variations; in MISSIONARY1 the female was not flexing her hips or knees and the male was supporting his upper body with his hands, but in MISSIONARY2, the female was flexing her hips and knees and the male was supporting his upper body with his elbows. SIDELYING – rear-entry, female side-lying on her left side, male side-lying behind – did not have any variations. To determine if each coital position had distinct spine and hip kinematic and muscle activation profiles, separate univariate general linear models (GLM) (factor: coital position = five levels, α=0.05) followed by Tukey’s honestly significant difference (HSD) post hoc analysis were used. To determine if simulated coitus was representative of real coitus across all spine and hip kinematic and muscle activation outcome variables, paired-sample t-tests (α=0.05) were performed on all outcome variables for the real condition and their respective simulated values. In general, the coital positions studied showed that, for both males and females, coitus is mainly a flexion-extension movement of the lumbar spine and hips. Males used a greater range of their spine and hip motion in comparison to females. As expected, differences were found between coital positions for males and females and simulated coitus was not representative of real coitus, in particular the spine and hip kinematic profiles. The results found in this biomechanical analysis of common coital positions may be useful in a clinical context. It is recommended that during the acute stage of a low back injury resulting in flexion-, extension-, or motion-intolerance that coitus be avoided. If the LBP is a more chronic issue, particular common coital positions should be avoided. For the flexion-intolerant male patient, avoid SIDELYING and MISSIONARY2 as they were shown to require the most flexion. Both variations of QUADRUPED are the more spine-sparing of coital positions followed by, MISSIONARY1. Coaching the male patient on proper hip-hinging technique while thrusting – an easy technique to incorporate in both variations of QUADRUPED – will likely decrease spine movement and increase the spine-sparing quality of QUADRUPED. For the flexion-intolerant female patient, avoid both variations of MISSIONARY, especially with hip and knee flexion, as they were shown to elicit the most spine flexion. QUADRUPED2 and SIDELYING are the more spine-sparing coital positions, followed by QUADRUPED1. Subtle posture changes for a coital position should not be considered lightly; seemingly subtle differences in posture can change the spine kinematic profile significantly, resulting in a coital position that was considered spine-sparing becoming a position that should be avoided. Thus, spine-sparing coitus appears to be possible for the flexion-, extension-, and motion-intolerant patient. Health care practitioners may recommend appropriate coital positions and coach coital movement patterns, such as speed control and hip-hinging. With respect to future research in the area of sex biomechanics, using simulated coitus in replace of real coitus is not justifiable according to the data of this study. However, including a simulated condition did prove beneficial for increasing the comfort level of the couples and allowing time to practice the experimental protocol. Future directions may address female-centric positions (e.g., ‘reverse missionary’ with male supine and female seated on top), and back-pained patients with and without an intervention (e.g., movement pattern coaching or aides, such as a lumbar support).

The thoracolumbar transversospinal muscles are vital in normal function and are implicated in the pathogenesis of different forms of spinal pathology and pain. They are the target for specific forms of clinical intervention such as exercise regimens and the release of �trigger points�, and are often analysed through imaging studies and electromyographic recordings. Despite the importance of these muscles, there is a paucity of knowledge in regard to aspects of their functional morphology. The aim of this thesis was to examine the thoracolumbar transversospinal muscles between the mid-thoracic spine and sacrum, examining their gross morphology, fibre arrangement, fibre types, and an animal model in order to provide a better understanding of their functional morphology. The gross morphology of these muscles was studied by micro-dissection of cadaveric material. Their form was found to differ from that published in either text book or peer reviewed articles, clearly indicating the existence of a �semispinalis� muscle in the lumbar spine. In addition, the arrangement of these muscles was found to be homologous between the thoracic and lumbar regions, which is contrary to published descriptions. Arrangement of the muscle fibres was examined by identifying motor endplates with acetylcholinesterase histochemistry in all muscles throughout the area of interest. Only one endplate per fibre was observed, and no in-series fibres were found. All muscles showed a complex multipinnate form with large areas of muscle tendon intruding into each muscle. Fibre type proportions in each muscle were investigated by immunohistochemistry. Results indicate the percentage of total muscle area occupied by type I fibres decreased the more caudad the vertebral level of origin, for all muscles. There were significant differences in the area percentage of type I fibres between many different vertebral levels. These differences were mostly found between the most cranial and most caudal levels examined. The percentage of type I fibres recorded suggest all muscles are likely postural in function, and the gradual decrease in type I fibres and the lack of a distinct thoracic / lumbar boundary in the data suggests the thoracic and lumbar transversospinal muscles are homologous. The thoracolumbar transversospinal muscles of the MLC3F nlacZ transgenic mouse were micro-dissected to determine their morphology, and their fibre arrangement subsequently determined using acetylcholinesterase histochemistry. These muscles showed a homogeneous form throughout the thoracolumbar spine, and no in-series muscle fibres were observed with all muscles having one motor endplate per fibre. Results indicated similarities between the morphology of mouse and human transversospinal muscles, perhaps indicative of an adaptation to an upright posture. This thesis provides information that facilitates a more complete understanding of the morphology and function of the thoracolumbar transversospinal muscles. In addition, results indicate that these muscles are homologous through the thoracic and lumbar spine, and therefore the classification and nomenclature used to describe these muscles should be re-examined. Furthermore, the morphological evidence, combined with recent embryological studies, supports the use of the term �spinotransverse� to more accurately describe this muscle group.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.

Thesis (Ph.D.)--University of Western Sydney, Macarthur, Faculty of Health, 1999. / References: p. 194-201.

Thesis (M.A.)--University of Delaware, 2007. / Principal faculty advisor: Anna Klintsova, Dept. of Psychology. Includes bibliographical references.

Thesis (M. Med. Sc.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 81-94). Also available in print.

Orientador: Alexandre César Rodrigues da Silva / Resumo: Neste trabalho avaliou-se a segmentação da coluna vertebral humana utilizando imagens externas da região dorsal. A avaliação foi realizada utilizando imagens de 70 pessoas (58 mulheres e 12 homens). Essas imagens foram agrupadas por meio da associação entre a quantidade de informação existente, dado pelo valor de entropia da imagem e uma avaliação qualitativa de visibilidade da musculatura paravertebral, realizada por três avaliadores. A segmentação foi feita utilizando um algoritmo, chamado DISLo (Dorsal Image Spine Locator), que processa imagens da região dorsal baseando-se na informação visível. Após o processamento, o algoritmo DISLo produz uma imagem binária contendo uma linha de pixels de intensidade 255 que representam a coluna vertebral identificada. Aplicando o algoritmo em todas as imagens, obteve-se uma segmentação de mais de 75% da coluna vertebral na maioria dos casos (40 imagens), e na minoria (4 imagens), menos de 25%. Posteriormente, para avaliar a qualidade da segmentação, utilizou-se o RMSD (Root Mean Square Deviation) calculado entre os pixels da segmentação automática do DISLo e outra realizada de modo manual, obtida da média de 9 avaliações realizadas por três avaliadores. Pôde-se verificar que as segmentações possuem uma exatidão maior em imagens com mais entropia, bem como possuem uma diferença no RMSD de +-2 pixels quando comparadas a imagens radiográficas. Portanto, a utilização de imagens externas da região dorsal para identificação da coluna vertebr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In this work, the segmentation of the human vertebral column was evaluated using external images of the dorsal region. The evaluation was performed using 70 individual images (58 women and 12 men). These images were grouped using the association between the amount of existing information, given by the entropy value of the image, and a qualitative assessment of the paravertebral musculature visibility, performed by three evaluators. The segmentation was performed using an algorithm called DISLo (Dorsal Image Spine Locator) which processes images from the dorsal region, based on the visible information. After the processing, the DISLo algorithm produces a binary image containing a line with pixels having a 255 intensity value that represents the identified backbone. Applying the algorithm to all images resulted in a segmentation of more than 75% of the spine in most cases (40 images), and in the minority (4 images), less than 25%. Subsequently, to evaluate the quality of the segmentation, the RMSD (Root Mean Square Deviation) was calculated between the pixels of DISLo's automatic segmentation and a manual one, obtained from the average of 9 evaluations performed by three evaluators. It could be verified that the segmentations have a greater accuracy in images with more entropy as well as having a difference in the RMSD of +-2 pixels when compared to radiographic images. Therefore, the use of external images of the dorsal region for identification of the spine is viable, and a r... (Complete abstract click electronic access below) / Doutor

Inertial measurement units (IMUs) are being recognized as a portable and cost-effective alternative to motion analysis systems and have the potential to be introduced into clinical settings for the assessment of functional movement quality of the spine in patients with low back pain. However, uncertainties regarding sensor accuracy and reliability are limiting the widespread use and acceptance of IMU-based assessments into routine clinical practice. The objective of this work was to assess the performance of inexpensive wearable IMUs (Mbientlab MetaMotionR IMUs; Mbientlab Inc., San Francisco, USA; product specifications available in Appendix C) relative to conventional optical motion capture equipment (Vicon Motion Systems Ltd., Oxford, UK) in: 1) a controlled environment, and 2) an uncontrolled environment. The first study evaluated the performance of 2 IMUs in a controlled environment during simulated repetitive spine motion carried out by means of a motorized gimbal. Root mean square error (RMSE) and mean absolute measurement differences between cycle-to-cycle minimum, maximum, and range of motion values, as well as correlational analyses within IMUs and between IMUs and Vicon, in all movement directions (i.e., simulated flexion-extension (FE), lateral bending (LB), and axial twisting (AT)), were compared. Measurement error was low in all axes during all tests (i.e., ≤ 1.54°); however, low-to-moderate correlational results were found in one non-primary axis, and this axis changed depending on the direction of the movement (i.e., LB during FE-motion (0.244 ≤ R ≤ 0.515), AT during LB-motion (0.594 ≤ R ≤ 0.795), and FE during AT-motion (0.002 ≤ R ≤ 0.255)). The second study was designed to assess the performance of the IMUs in an uncontrolled environment during repetitive spine FE in human participants. Absolute angles and local dynamic stability were compared for individual IMUs (which were placed over T10-T12 spinous processes, and the pelvis) as well as for relative motion between IMUs. Maximum finite-time Lyapunov exponents (λmax) were used to quantify local dynamic stability and were calculated using both FE and the sum of squares (SS) from measured spine kinematics. It was found that the IMUs have acceptable performance in all axes when tracking motion (RMSE ≤ 2.43°); however, low-to-moderate correlational results were found in one non-primary axis (0.987 ≤ RFE ≤ 0.998; 0.746 ≤ RLB ≤ 0.978; 0.343 ≤ RAT ≤ 0.679). In addition, correlations between λmax estimates were high; therefore, local dynamic stability can be accurately estimated using both FE and SS data (0.807 ≤ 〖ICC〗_2,1^FE ≤ 0.919; 0.738 ≤ 〖ICC〗_2,1^SS ≤ 0.868). Correlation between λmax estimates was higher when using FE data for individual sensors/rigid-body marker clusters; however, correlation was higher when using SS data for relative motion. In general, the results of these studies show that the MetaMotionR IMUs have acceptable performance in all axes when considering absolute angle orientation and motion tracking, and measurement of local dynamic stability; however, there is low-to-moderate correlation in one non-primary axis, and that axis changes depending on the direction of motion. Future research will investigate how to optimize performance of the third axis for motion tracking; it will also focus on understanding the significance of the third axis performance when calculating specific outcome measures related to spine movement quality.

Low back pain is the most common cause of disability in the United Kingdom with health care costs of more than 1 billion pounds per year. One reason associated with low back pain is the degeneration of intervertebral discs due to loads on the spine. Daily postures such as standing and sitting produce different loads on the discs. Previously, many studies investigated the stress and pressure within the disc in these postures. The results do not agree with each other and the experiments have many limitations. The aim of this project was to assess the feasibility of incorporating magnetic resonance (MR) imaging and finite element (FE) analysis to predict the pressure and stresses developed by different daily postures in an individual. Transient and non-transient subject specific 2D models of nine individuals in standing and sitting were created based on previously acquired MR images. The geometry of these FE models was based on supine MR images. The sitting and standing boundary conditions were calculated by comparing their MR images with the supine posture. The results showed that for six subjects sitting created more intradiscal pressure compared to standing and in one subject standing more than sitting. For two of the subjects the pressure was nearly the same in sitting and standing. Because of the 2D model’s limitations, 3D models of an individual were developed. Both transient and non-transient models of the individual were created. The intradiscal pressure results were three times lower compared to the 2D models. This was due to consideration of out of plane deformation in the 3D models. These results were in the range of in-vivo and in-vitro measurements available in the literature. In conclusion, it was possible to create kinematic transient subject specific FE models based on the MR images in different postures. 2D models provide a method for comparing the postures but 3D models may be more realistic.

O presente estudo analisou o comportamento eletromiográfico de vários níveis dos músculos póstero-mediais do tronco, bilateralmente, para verificar a ocorrência de ativação elétrica simétrica e em busca de padrões de comportamento para embasar modelos biomecânicos. A amostra foi composta por 16 indivíduos saudáveis de ambos gêneros. Todas as execuções foram filmadas para análise cinemática, enquanto a atividade elétrica foi coletada com 14 pares de eletrodos de superfície dispostos lateral e simetricamente ao longo da coluna vertebral nos níveis da sétima vértebra cervical (C7), terceira, sexta e nona vértebras torácicas (T3, T6 e T9) e primeira, terceira e quinta vértebras lombares (L1, L3 e L5). Somente os gestos considerados simétricos através da cinemetria foram analisados. Para a análise do sinal eletromiográfico o gesto de levantar a carga foi dividido em quatro fases, considerando-se apenas a fase de subida com carga. A atividade elétrica dessa fase foi normalizada pela contração isométrica voluntária máxima. Utilizando uma ANOVA, os níveis vertebrais adjacentes foram agrupados em busca de ativação elétrica similar, foi adotado o nível de significância de p<0,05. Os resultados demonstraram que a ativação eletromiográfica não ocorre de maneira simétrica e que é possível identificar zonas com comportamento elétrico distinto entre elas, sendo que as maiores médias estavam localizadas nas regiões mais inferiores do tronco. / The present study analysed the electromyographical behaviour at various levels of posterior medial muscles on trunk, bilaterally, during load lifting to verify the occurrence of symmetry on electrical activation and to search patterns which could provide or supply biomechanical models. Sixteen healthy subjects were videotaped the 2D movement and the EMG signal was registered from 14 pairs of surface electrodes arranged symmetrically and bilaterally throughout trunk, specifically at seventh cervical vertebra (C7), third, sixth and ninth thoracic vertebra (T3, T6 and T9) and first, third and fifth lumbar vertebra (L1, L3 and L5). Only the symmetrical movements, from kinematical point-of-view, were analysed. The EMG analysis was divided in four phases and it was used in the present study the load lifting part. The electrical activation values of this phase were normalized by maximal voluntary isometric contraction. ANOVA was used to provide the adjacent groups in which electrical activation were similar. Differences were considered significant at a p<0.05. The results demonstrated the electromyographical activation does not occur in symmetrical way and, besides it was possible identify zones based on different electrical behaviours, taking into account the largest means were located on lower trunk region.