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Multifidus Denervation After Radiofrequency Ablation of the Medial Nerve Alters the Biomechanics of the Spine—A Computational Study

Faris A. Almalki and Daniel H. Cortes

Radiofrequency ablation of the medial branch is commonly used to treat chronic low back pain involving facet joints, which accounts for 12% to 37% of the total cases of chronic low back pain. An adverse effect of this procedure is the denervation of the multifidus muscle, which may lead to its atrophy which can affect the spine and possibly disc degeneration. This study aims to quantify changes in joint angles and loading caused by multifidus denervation after radiofrequency ablation. AnyBody model of the torso was used to evaluate intervertebral joints in flexion, lateral bending, and torsion. Force-dependent kinematics was used to calculate joint angles and forces. These dependent variables were investigated in intact multifidus, unilateral, and bilateral ablations of L3L4, L4L5, and L5S1 joints. The results showed pronounced angular joint changes, especially in bilateral ablations in flexion, when compared with other cases. The same changes’ trend from intact to unilaterally then bilaterally ablated multifidus occurred in joint angles of lateral bending. Meanwhile, joint forces were not adversely affected. These results suggest that multifidus denervation after radiofrequency ablation affects spinal mechanics. Such changes may be associated with abnormal tissue deformations and stresses that can potentially alter their mechanobiology and homeostasis, thereby possibly affecting the health of the spine.

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Prediction of Model Generated Patellofemoral Joint Contact Forces Using Principal Component Prediction and Reconstruction

Myles Ashall, Mitchell G.A. Wheatley, Chris Saliba, Kevin J. Deluzio, and Michael J. Rainbow

It is not currently possible to directly and noninvasively measure in vivo patellofemoral joint contact force during dynamic movement; therefore, indirect methods are required. Simple models may be inaccurate because patellofemoral contact forces vary for the same knee flexion angle, and the patellofemoral joint has substantial out-of-plane motion. More sophisticated models use 3-dimensional kinematics and kinetics coupled to a subject-specific anatomical model to predict contact forces; however, these models are time consuming and expensive. We applied a principal component analysis prediction and regression method to predict patellofemoral joint contact forces derived from a robust musculoskeletal model using exclusively optical motion capture kinematics (external approach), and with both patellofemoral and optical motion capture kinematics (internal approach). We tested this on a heterogeneous population of asymptomatic subjects (n = 8) during ground-level walking (n = 12). We developed equations that successfully capture subject-specific gait characteristics with the internal approach outperforming the external. These approaches were compared with a knee-flexion based model in literature (Brechter model). Both outperformed the Brechter model in interquartile range, limits of agreement, and the coefficient of determination. The equations generated by these approaches are less computationally demanding than a musculoskeletal model and may act as an effective tool in future rapid gait analysis and biofeedback applications.

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A Narrative Review of Personalized Musculoskeletal Modeling Using the Physiome and Musculoskeletal Atlas Projects

Justin Fernandez, Vickie Shim, Marco Schneider, Julie Choisne, Geoff Handsfield, Ted Yeung, Ju Zhang, Peter Hunter, and Thor Besier

In this narrative review, we explore developments in the field of computational musculoskeletal model personalization using the Physiome and Musculoskeletal Atlas Projects. Model geometry personalization; statistical shape modeling; and its impact on segmentation, classification, and model creation are explored. Examples include the trapeziometacarpal and tibiofemoral joints, Achilles tendon, gastrocnemius muscle, and pediatric lower limb bones. Finally, a more general approach to model personalization is discussed based on the idea of multiscale personalization called scaffolds.

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Modeling Human Suboptimal Control: A Review

Alex Bersani, Giorgio Davico, and Marco Viceconti

This review paper provides an overview of the approaches to model neuromuscular control, focusing on methods to identify nonoptimal control strategies typical of populations with neuromuscular disorders or children. Where possible, the authors tightened the description of the methods to the mechanisms behind the underlying biomechanical and physiological rationale. They start by describing the first and most simplified approach, the reductionist approach, which splits the role of the nervous and musculoskeletal systems. Static optimization and dynamic optimization methods and electromyography-based approaches are summarized to highlight their limitations and understand (the need for) their developments over time. Then, the authors look at the more recent stochastic approach, introduced to explore the space of plausible neural solutions, thus implementing the uncontrolled manifold theory, according to which the central nervous system only controls specific motions and tasks to limit energy consumption while allowing for some degree of adaptability to perturbations. Finally, they explore the literature covering the explicit modeling of the coupling between the nervous system (acting as controller) and the musculoskeletal system (the actuator), which may be employed to overcome the split characterizing the reductionist approach.

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Open Foot Stance Reduces Lead Knee Joint Loading During Golf Swing

Hannah Stokes, Rafael Escamilla, Joseph Bellapianta, Hongsheng Wang, Tyson Beach, Dave Frost, and Naiquan Zheng

Foot stance and club type’s relationship with lead knee joint biomechanics and possible involvement with injury incidences in amateur golfers have not been evaluated. This study included 16 male right-handed amateur golfers who performed golf swings with 2 different foot stances (straight and open) using 4 different club types (driver, 3 iron, 6 iron, and 9 iron) while standing on 2 force plates in a motion capture laboratory. A custom program calculated the kinematics and kinetics of the lead knee. Overall, the open stance reduced most translations, rotations, forces, and torques of the lead knee in all 4 club types when compared with the straight stance. The open stance reduced the rotation motion (−28%), compressive force (−5%), and rotation torque (−9%) when compared with the straight stance, which are the highest contributors to grinding of cartilage. The driver club had significantly larger values in most translations, rotations, forces, and torques when compared among the 4 club types. The open stance reduced the rotation motion, compressive force, and rotation torque in the lead knee joint compared with the straight stance. Lead knee joint biomechanics should be monitored to reduce injury in amateur golfers.

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A Digital Twin Framework for Precision Neuromusculoskeletal Health Care: Extension Upon Industrial Standards

David J. Saxby, Claudio Pizzolato, and Laura E. Diamond

There is a powerful global trend toward deeper integration of digital twins into modern life driven by Industry 4.0 and 5.0. Defense, agriculture, engineering, manufacturing, and urban planning sectors have thoroughly incorporated digital twins to great benefit across their respective product lifecycles. Despite clear benefits, a digital twin framework for health and medical sectors is yet to emerge. This paper proposes a digital twin framework for precision neuromusculoskeletal health care. We build upon the International Standards Organization framework for digital twins for manufacturing by presenting best available computational models within a digital twin framework for clinical application. We map a use case for modeling Achilles tendon mechanobiology, highlighting how current modeling practices align with our proposed digital twin framework. Similarly, we map a use case for advanced neurorehabilitation technology, highlighting the role of a digital twin in control of systems where human and machine are interfaced. Future work must now focus on creating an informatic representation to govern how digital data are passed to, from, and within the digital twin, as well as specific standards to declare which measurement systems and modeling methods are acceptable to move toward widespread use of the digital twin framework for precision neuromusculoskeletal health care.

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The Effect of the Nordic Hamstring Exercise on Muscle Activity: A Multichannel Electromyography Randomized Controlled Trial

Jozef J.M. Suskens, Huub Maas, Jaap H. van Dieën, Gino M.M.J. Kerkhoffs, Edwin A. Goedhart, Johannes L. Tol, and Gustaaf Reurink

The aim of this study was to evaluate the effect of a Nordic hamstring exercise intervention on biceps femoris long head, semitendinosus, and semimembranosus muscle’s activity and relative contributions through multichannel electromyography. Twenty-four injury-free male basketball players (mean age 20 [3] y) were randomly assigned to a 12-week intervention (n = 13) or control group (n = 11). The primary outcome measures were normalized muscle activity (percentage of maximal voluntary isometric contraction, %MVIC) and relative contribution of hamstring muscles over 12 weeks. No effects were found on any of the primary outcome measures. Between-group differences over 12 weeks were 2.7%MVIC (95% confidence interval 95% CI, −0.7 to 6.1) for the biceps femoris long head, 3.4%MVIC (95% CI, −1.4 to 8.2) for the semitendinosus, and 0.8%MVIC (95% CI, −3.0 to 4.6) for the semimembranosus, P = .366. Between-group differences over 12 weeks were 1.0% relative contribution (%con; 95% CI, −3.0 to 5.1) for the biceps femoris long head, 2.2% relative contribution (95% CI, −2.8 to 7.2) for the semitendinosus, and −3.3% relative contribution (95% CI, −6.4 to −0.1) for the semimembranosus P = .258. A positive value implies a higher value for the Nordic group. A Nordic hamstring exercise intervention did not affect the level of muscle activity and relative contribution of hamstring muscles in performance of the Nordic hamstring exercise.

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Predicting Gait Patterns of Children With Spasticity by Simulating Hyperreflexia

Kirsten Veerkamp, Christopher P. Carty, Niels F.J. Waterval, Thomas Geijtenbeek, Annemieke I. Buizer, David G. Lloyd, Jaap Harlaar, and Marjolein M. van der Krogt

Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment.

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Volume 39 (2023): Issue 4 (Aug 2023)

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Preparing to Land: Hamstring Preactivation Is Higher in Females and Is Inhibited by Fatigue

David Alan Phillips, Bridgette Rae Buckalew, Bridget Keough, and Jacklyn Stephanie Alencewicz

The hamstring plays an important role in reducing loads born by the anterior cruciate ligament. As anterior cruciate ligament injuries occur rapidly after ground contact, how the hamstring is activated prior to landing can influence injury risk. The purpose was to determine sex-related differences in hamstring activation immediately before landing and the effect of fatigue on “preactivation.” Twenty-four participants (13 males and 11 females, age = 24.3 [6.5] y, mass = 72.2 [19.3] kg, height = 169 [9.7] cm) participated in this study. Participants completed a drop-vertical jump protocol before and after a lower body fatigue protocol. Hamstring electromyography (EMG) amplitude at 5 periods prior to landing, peak vertical ground reactions forces (in newtons/body weight), rate of loading (in body weight/second), and landing error scoring system were measured. Females had higher EMG amplitude before and after fatigue (P < .024), with decreased EMG amplitude for both sexes after fatigue (P = .025). There was no change on vertical ground reaction force, rate of loading, or landing error scoring system. Males and females demonstrated similar landing performance before and after fatigue but have different hamstring neuromuscular coordination strategies. The acute reduction in hamstring EMG amplitude following fatigue may increase loading on the anterior cruciate ligament.