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The influence of simulated transversus abdominis muscle force on sacroiliac
joint flexibility during asymmetric moment application to the pelvis
Rafael Gnat, Kees Spoor, Annelies Pool-Goudzwaard
PII:
DOI:
Reference:
S0268-0033(15)00170-9
doi: 10.1016/j.clinbiomech.2015.06.006
JCLB 3986
To appear in:
Clinical Biomechanics
Received date:
Accepted date:
19 February 2015
8 June 2015
Please cite this article as: Gnat, Rafael, Spoor, Kees, Pool-Goudzwaard, Annelies, The
inuence of simulated transversus abdominis muscle force on sacroiliac joint exibility
during asymmetric moment application to the pelvis, Clinical Biomechanics (2015), doi:
10.1016/j.clinbiomech.2015.06.006
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The influence of simulated transversus abdominis muscle force on sacroiliac
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a,b,c
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Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box
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Rafael Gnat
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Corresponding author:
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ul. Mikolowska 72
40-065 Katowice
Poland
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ABSTRACT
Background
The role of so-called local muscle system in motor control of the lower back and
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this system were recently challenged. This study investigated the impact of in
vitro simulated force of transversely oriented fibres of the transversus abdominis
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muscle (a part of the local system) on flexibility of the sacroiliac joint during
asymmetric moment application to the pelvis.
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Methods
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Ranges of motion of the sacroiliac joint were recorded using the Vicon Motion
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Findings
Flexibility of the sacroiliac joint was significantly bigger during anterior rotation
of the innominate, as comapred to posterior rotation (Anova P<0.05). After
application of simulated force of transversus abdominis, flexibility of the joint did
not change both during anterior and posterior rotations of the innominate.
Interpretation
A lack of a stiffening effect of simulated transversus abdominis force on the
sacroiliac joint was demonstrated. Earlier hypotheses suggesting a stiffening
influence of this muscle on the pelvis cannot be confirmed. Consistent with
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previous findings smaller flexibility of the joint recorded during posterior rotation
of the innominate may be of clinical importance for physio- and manual
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1. INTRODUCTION
The role of so-called local muscle system (Bergmark 1989) in motor
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2001ab, Ferreira et al. 2006, 2007, Tsao and Hodges 2007) were recently
challenged (Cleland et al. 2002, Koumantakis et al. 2005, Mills et al. 2005,
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Allison and Morris 2008, Mannion et al. 2008, Lederman 2010, Burns et al.
2011, Reeves et al. 2011, Hodges et al. 2013). Indeed, earlier evidence
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from the lower lumbar spine and pelvis (e.g. transversus abdominis (TrA),
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lumbar multifidus, pelvic floor), have the potential to decrease flexibility and
thus stabilize the articular junctions. In case of the pelvis, Richardson et al.
(2002) reported that after voluntary contraction of the TrA, laxity of the
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stiffening effect of simulated TrA muscle force on the pubic symphysis in
vitro. In line with their results, also the claim of a stiffening effect of TrA on
the sacroiliac joint (SIJ) seems questionable, although the anatomy and
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Goudzwaard et al. 2004, Pel et al. 2008).To our knowledge no in vitro study
has proven the stiffening effect of simulated TrA activity on the SIJ.
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innominate with respect to the other were used to mimic the natural
behaviour of the pelvis during e.g. locomotion. Our secondary objective was
to compare SIJ flexibility for flexion and extension rotations of the
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Findings of this study can be of importance in the debate whether
local muscles indeed have a stabilizing function in contrast to other muscles
of the trunk. Outcome of this debate can interfere with current treatment
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SIJ flexibility for flexion and extension of the innominate relative to the
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sacrum may also add to our understanding of SIJ function in human gait.
2. METHODS
2.1. Material
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70.3 (5) years, embalming time 3-6 months) consisting of the pelvis and L5
vertebrae with all ligaments and capsules intact were available.
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innominate in the sagittal plane while the other innominate was fixed to a
custom-made frame (Fig. 1). To enable both torque application to one
innominate and fixation of the opposite innominate, a rigid metal plate was
screwed to each innominate through the compact bone at the height of the
iliac crest, above the acetabulum and through the ischial tuberosity. One
plate was attached to the frame to fix the bone, while the second was
connected to a steel bar and axle to allow application of an incremental force
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resulting in a moment in the sagittal plane. To allow three-dimensional
movements of the innominate on the non-fixed side and the sacrum, the axle
was equipped with two universal joints and one prismatic sliding joint (Fig. 1).
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system installed on the frame. The force was transmitted by non-elastic cord
to a steel disk (diameter 300 mm) and then to the axle and innominate. To
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calculate the real moment applied to the bone a torque transducer was
placed between the steel disk and the bar with two universal joints (Fig.1).
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motion of the SIJ in the sagittal plane during the specimen loading. To
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achieve this the Vicon MX Motion Capture System (Vicon Motion Systems,
Oxford, UK) was used. A total of 11 reflective markers (diameter 9.5 mm)
were screwed to the specimen (4 per each innominate, 3 per sacrum). To
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estimated on a mechanical model was equal to 0.1 deg for angular and 0.1
mm for linear measurements.
During each test an incremental torque was first applied to either the
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destruction when maximal loads were in use. The torque during each load-
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completed, the position of the markers was captured in the Vicon system
with a 10 s latency.
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flexion torque in the sagittal plane (FT, anterior rotation about Y-axis of the
reference system (Fig.2)), the load was step-wise released until the moving
innominate returned to its neutral position. This was directly followed by a
step-wise increasing of extension torque (ET, posterior rotation about Y-axis
of the reference system). Subsequently, the ET load was released until the
neutral position. Finally, FT was step-wise applied again until its maximum.
After each step positions of the markers were captured. The number of loadsteps during application of FT and ET was not fixed. To measure the range
of motion during the procedure an electronic goniometer was mounted on
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the steel disk (Fig.1). The load increments were ceased when during two
consecutive, final load-steps the range of motion (ROM) recorded by the
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holes at the height of the anterior superior iliac spines (Fig. 2), pulling them
towards each other with a force of 120 5 N (Mens et al. 2006, Pel et al.
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2008).
The whole procedure was repeated with the torque applied to the
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unloaded state maximal FT (Fig. 3 shows qualitatively an example of a
load deformation curve).
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were calculated from the positions of the sacral and innominate markers
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after each loading step (Spoor and Veldpaus 1980, Sderkvist and Wedin
1993).The sagittal plane SIJ ROM is represented by the rotations of the
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rotation about the Y-axis; extension is posterior rotation about the Y-axis
The coordinate system was attached to the fixed innominate bone.
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of the measurement and two directions of torque application: FT and ET) for
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trajectories t1 and t2. Slopes of the adjusted linear regression lines (ROM vs
torque) were calculated. As visible in Figure 3, two regression lines for each
direction of torque application (FT and ET) were drawn and two slopes were
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calculated (F1, F2 and E1, E2). The mean value of the two slopes for each
torque direction was considered a measure of SIJ flexibility. Defined in such
way, the slope is directly proportional to flexibility of the joint.
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mixed model of Anova with one independent factor: torque direction (FT and
ET) as well as one repeated factor: series of measurement (side 1 of the
pelvis; side 1 with TrA; side 2 of the pelvis; side 2 with TrA). Significance
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3. RESULTS
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51.75 (SD 11.14) Nm and 52.62 (SD 10.80) Nm, respectively. No significant
difference was found between them.
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results revealed significant main effect for the independent factor, i.e. torque
direction (F=4.826; P=0.037). The FT slope (marginal mean 0.022 deg/Nm)
was significantly bigger than ET slope (marginal mean 0.014 deg/Nm),
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4. DISCUSSION
In this study the SIJ flexibility was investigated in two experimental
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recorded levels of flexibility with outcomes of other studies since only few
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current study lower levels of flexibility were registered (maximal mean slope
of 0.025 deg/Nm for FT with TrA force simulation in series 2, Tab.1). Such
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embalming time (the two studies mentioned above do not provide data on
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embalment duration).
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are several possible explanations for such findings. First of all, exclusively
the transverse portion of the TrA fibres was mimicked in vitro. The rationale
for this was that only from these fibres a large compressive force on the
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current setting. Such a simplified model was unable to reflect the whole
spectrum of physiologic behaviour of both the TrA and other local muscles. It
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is known that in vivo activation of the TrA takes place in synergy with pelvic
floor muscles (Sapsford et al. 2001ab) and the diaphragm (Allison et al.
1998, Hodges and Gandevia 2000). Simulation of these muscle forces might
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have more strongly influence the flexibility of the SIJ. Observations from an
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more complex specimen than used in the present study (pelvis, lumbar and
lower thoracic spine with ribs), and reproduction of multiple vectors
generated by the TrA and other deep muscles, would help to more
realistically verify the hypothesis concerning their role in decreasing flexibility
of the pelvic girdle. These observations (Richardson et al. 2002, PoolGoudzwaard et al. 2004, Pel et al. 2008) allow to speculate that muscle
synergisms and coactivation within the local system have greater impact on
the flexibility of the pelvic region than isolated activation of single muscles.
This issue has already been addressed by others (e.g. Cholewicki et al.
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1997, Gardner-Morse and Stokes 1998). It might also be clinically relevant.
Within many therapeutic approaches (both older and modern) exercises are
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muscles (Pilates and Miller 1945, Richardson and Jull 1995, Hides et al.
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1996, OSullivan et al. 1997, Comerford and Mottram 2001, Stuge et al.
2004). To date, no data are available demonstrating that restoration of such
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therapy, when applying manual thrust techniques or mobilizations
incorporating anterior innominate rotation movement there may be a need to
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Apart from the fact that only the transverse portion of the TrA fibres
was mimicked, other limitations of the present study need to be addressed.
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First, the limitations linked to in vitro studies are known and inherent.
Conclusions derived from cadaveric data cannot be directly applied to living
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that loads applied in this study exceeded those associated with normal daily
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life activity. Moreover, the SIJ loads in vivo depend on muscle forces and
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are therefore different from the passive loads in cadaveric experiments, with
consequences for relative bone positions. The history of our specimens
remained unknown as well. It was only possible to exclude specimens with
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5. CONCLUSIONS
1. A lack of a stiffening effect of simulated TrA muscle force on SIJ was
demonstrated. Earlier hypotheses suggesting a stiffening influence of this
muscle on the pelvis cannot be confirmed.
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2. Flexibility of the SIJ was smaller for extension of the innominate relative to
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CONFLICT OF INTEREST
We inform that no sponsors were involved in the study. All expenses were covered by
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ACKNOWLEDGEMENTS
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We would like to acknowledge the kind assistance of very talented Mrs. Karine
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TABLES
Table 1. Mean values (standard deviations)(deg/Nm) of the slopes recorded for sagittal plane
rotations of the innominate in relation to the sacrum (about Y axis of the reference system)
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during application of flexion (FT) and extension (ET) torques and for four series of measurement:
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1) torque applied to side 1 of the pelvis; 2) torque applied to side 1 of the pelvis with simulated
transversus abdominis (TrA) force; 3) torque applied to side 2 of the pelvis; 4) torque applied to
series 1
series 2
series 3
series 2
0.022 (0.012)
0.025 (0.017)
0.020 (0.012)
0.020 (0.013)
0.13 (0.007)
0.12 (0.008)
0.14 (0.007)
0.15 (0.010)
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Torque
FT
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FIGURE CAPTIONS
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innominates, one fixed to the frame, the other connected to a steel bar with
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two universal joints (B), a torque transducer (C), a pulley (D) and a prismatic
sliding joint (E). Electronic goniometer (F) was used to control range of
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Figure 2. The coordinate system and position of the sacral (S 1,2,3) and
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rubber band imitating the force exerted by the transversus abdominis muscle
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the innominate in relation to the sacrum about the Y axis of the reference
system (flexion(positive)/extension(negative)). Data from the first stage (i.e.
unloaded state maximal flexion torque (FT)) were ignored (not shown).
Only the two trajectories were used for the analysis: t1) maximal FT
unloaded state maximal extension torque (ET), and t2) maximal ET
unloaded state maximal FT. Adjusted linear regression lines for t1 and t2
are presented by dotted lines. Two regression lines were drawn for ET (E1
and E2) and two other for FT (F1 and F2). Slopes of these regression lines
were regarded as measures of flexibility. The mean value of slopes E1 and
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E2 and the mean value of slopes F1 and F2 were calculated and subjected
to further analysis. Defined this way, the slope is directly proportional to joint
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flexibility.
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Figure 4. Marginal mean values of the slopes of regression lines recorded for
the two factors of Anova design (main effects): independent (A) torque
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Figure 1
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Figure 2
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Figure 3
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Figure 4
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HIGHLIGHTS
Flexibility of the sacroiliac joint was investigated in vitro.
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procedure.
Simulation o the muscle force did not decrease flexibility of the joint.
This effect ocurred both during anterior and posterior rotations of the
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rotation.
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innominate.
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