Proceedings of the Institution of Mechanical

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Design and evaluation of a novel triaxial isometric trunk muscle strength measurement system
M R Azghani, F Farahmand, A Meghdari, G Vossoughi and M Parnianpour
Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2009 223: 755
DOI: 10.1243/09544119JEIM537

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 755

Design and evaluation of a novel triaxial isometric

trunk muscle strength measurement system
M R Azghani1, F Farahmand1,2*, A Meghdari1, G Vossoughi1, and M Parnianpour1,3
1
Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
2
RCSTIM, Tehran University of Medical Sciences, Tehran, Iran
3
Information & Industrial Engineering, Hanyang University, Seoul, Republic of Korea

The manuscript was received on 27 October 2008 and was accepted after revision for publication on 6 April 2009.

DOI: 10.1243/09544119JEIM537

Abstract: Maximal strength measurements of the trunk have been used to evaluate the
maximum functional capacity of muscles and the potential mechanical overload or overuse of
the lumbar spine tissues in order to estimate the risk of developing musculoskeletal injuries. A
new triaxial isometric trunk strength measurement system was designed and developed in the
present study, and its reliability and performance was investigated. The system consisted of
three main revolute joints, equipped with torque sensors, which intersect at L5S1 and
adjustment facilities to fit the body anthropometry and to accommodate both symmetric and
asymmetric postures in both seated and standing positions. The dynamics of the system was
formulated to resolve validly the moment generated by trunk muscles in the three anatomic
planes. The optimal gain and offset of the system were obtained using deadweights based on
the least-squares linear regression analysis. The R2 results of calibration for all loading courses
of all joints were higher than 0.99, which indicated an excellent linear correlation. The results of
the validation analysis of the regression model suggested that the mean absolute error and the
r.m.s. error were less than 2 per cent of the applied load. The maximum value of the minimum
detectable change was found to be 1.63 N m for the sagittal plane torque measurement, 0.8 per
cent of the full-scale load. The trial-to-trial variability analysis of the device using deadweights
provided intra-class correlation coefficients of higher than 0.99, suggesting excellent reliability.
The cross-talk analysis of the device indicated maximum cross-talks of 1.7 per cent and 3.4 per
cent when the system was subjected to flexionextension and lateral bending torques
respectively. The trial-to-trial variability of the system during in-vivo strength measurement
tests resulted in good to excellent reliability, with intra-class correlation coefficients ranging
from 0.69 to 0.91. The results of the maximum voluntary isometric torques exertion
measurements for 30 subjects indicated good agreement with the previously published data
in the literature. The extensive capabilities and high reliability of the system are promising for
more comprehensive investigations on the trunk biomechanics in future, e.g. isometric
strength measurement at symmetric and asymmetric postures, muscle endurance, and
recruitment pattern analysis.

Keywords: trunk, triaxial strength measurement, design, reliability, maximum voluntary

exertion

1 INTRODUCTION recent years, affecting the life of up to 85 per cent of

Low-back disorder (LBD) has become a problem of
epidemic proportion in the industrialized world in
*Corresponding author: Department of Mechanical Engineering,
Sharif University of Technology, Azadi Ave, Tehran, Iran.
email: farahmand@sharif.edu
adults [1]. The prevalence rate in the USA, Germany,
Norway, and Sweden in 1 year has been reported to
be 56 per cent, 59 per cent, 61 per cent, and 70
per cent respectively [24]. Results of investigations
conducted by Safety and Health Assessment and
Research for Prevention in Washington state during
1994 to 2002, indicated that the direct cost of LBD

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756 M R Azghani, F Farahmand, A Meghdari, G Vossoughi, and M Parnianpour
has been more than US $2.9 billion in this state [5].
Understanding the biomechanics of spine and the
role of its different components in developing
neuromusculoskeletal injuries is an essential pre-
requisite for design and implementation of any
effective prevention program and/or treatment of
LBD [6, 7]. It has been suggested that occupational
parameters, e.g. posture and duration of work
activities, affect the rate and onset of low-back-pain
complaints [8]. Mechanical overload or overuse of
the lumbar spine tissues due to the mismatch
between the functional capacity of the human body
and the physical requirements of daily activities is
considered to be the major cause of low-back pain
and spinal disorders [9]. As a result, several re-
searchers have attempted to measure the strength
of trunk muscles and to quantify their maximum
functional capacity using different assessment meth-
ods and devices at various loading conditions [10,
11]. The trunk muscles strength dynamometers
usually attempt to measure the generated uniaxial
[12, 13] or biaxial and triaxial [1012] lumbar mo-
ments about the L5S1 joint while simulating the
isometric, isokinetic, isoresistive, and isodynamic
muscle actions.
A limited number of biaxial and triaxial trunk
strength measurement systems have been described
in the literature. Davis et al. [14] developed a biaxial
device to measure the static (isometric) and dynamic
trunk moments in the sagittal and transverse planes
[14, 15]. The Isostation B200 (Isotechnologies Inc.,
Hillsborough, North Carolina, USA) is a triaxial
dynamometer developed for simultaneous measure-
ment of lumbar moments in three axes during
isometric and isoresistive muscle action [16]. This
device, however, suffers from a number of short-
comings, e.g. non-concurrency of the joint axes
resulting in erroneous data in the transverse plane,
inappropriate joint locking leading to slight motions
during isometric measurement, and inability to
allow for performing measurements in non-erect
postures [16]. Lariviere et al. [10] employed a six-axis
force sensor to develop a triaxial isometric device for
examination of lumbar moments and forces at L5S1
level. This system could be set for different trunk
positions in the sagittal plane but had no degree of
freedom in the coronal and transverse planes.
Finally, the recently introduced CTT Pegasus system
(BFMC Biofeedback-Motor-Control GmbH, Leipzig,
Germany) is capable of performing triaxial measure-
ments and dynamic tracking tests; however, it only
facilitates seated postures and is suffering the
aforementioned shortcoming due to its non-inter-
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secting joint axes, which makes the validity of
measured triaxial moments questionable [17].
The aim of this study was to develop a triaxial
trunk dynamometer capable of isometric strength
measurement at asymmetric posture while validly
resolving the moment generated by trunk muscles
in the three anatomic planes. A new device with
superior performance over the existing systems is
introduced which facilitates precise measurement of
lumbar moments at complex trunk postures, in both
seated and standing positions, and its calibration,
and validation procedures are described. 30 healthy
male subjects with no history of low back pain were
also tested using the device to provide a small
database for the healthy population and to compare
the results with the existing literature.
2 METHODS
2.1 Design and development
Triaxial isometric measurement of trunk muscles
strength involved two main tasks: first, adequate
accommodation of different body postures, and,
second, accurate and clinically meaningful measure-
ment and presentation of lumbar moments. The
device is needed to accommodate the body size of
the middle 95 per cent of adults, to provide sufficient
range of motion in all three anatomic planes based
on the ranges reported in the literature [18], and to
adapt itself to the position of the thorax in any
combination of the trunk angles (postures). Further-
more the device should have sufficient structural
strength and rigidity to withstand the maximum
lumbar moments of the middle 95 per cent of adults,
as reported in the literature [10, 11, 19, 20], safely
and with minimum deformation. Finally, the device
is required to be able to perform accurate measure-
ment of the resultant lumbar moments about the
L5S1 joint and to provide results in compatibility
with the commonly used clinical protocol using the
definitions of joint coordinate systems [19, 21, 22]
recommended by the International Society of Bio-
mechanics (ISB).
In order to measure the resultant trunk moments,
a variety of sensor arrangements could be employed.
A low-cost option was to use several (at least six)
uniaxial force sensors in the device to find the
moments indirectly; however, this caused much
complexity in the sensors installation and large
errors in the calculation of the resultant moments.
On the other hand, a six-axis force and torque sensor
JEIM537 F IMechE 2009
 Trunk muscle strength measurement system 757

solution, as suggested in a previous work [10], would

involve high instrumentation costs.
A reasonable solution could be obtained using
three uniaxial torque sensors in a special arrange-
ment which allowed direct measurement of moment
components without the need to measure the forces.
Assuming the trunk to be a rigid body, it has six
degrees of freedom in the space. However, as the
trunk can be assumed to rotate around the L5S1
joint, by attaching the coordinate system to this joint
the degrees of freedom reduce to three. Therefore, a
positioning mechanism with three revolute joints,
having axes pointed towards the L5S1 joint, would
accommodate the trunk well. With such a design, the
measurement and positioning mechanisms merged
and a three-degrees-of-freedom (3-DOF) mechan-
ism would be sufficient for both body-positioning
and torque measurement.
A 3-DOF mechanism with the above features
Fig. 1 The three-dimensional model of the trunk
could be realized using six different joint arrange- muscles strength measurement system includ-
ments [23, 24]. Considering the design requirements ing the main links and joints, the foot pedestal,
stated above, the best design among these was and the thoracic pad
chosen as is illustrated in Fig. 1. This mechanism
includes three revolute joints with the following a maximum deviation of 3.5 mm from the initially
arrangement from the ground: assumed concurrent configuration of the joint axes,
when the device was subjected to a static extension
(a) the joint connected to the base coordinate
torque of 400 N m, 10 per cent higher than the
system and related to the trunk axial rotation
maximum value reported in the literature [10, 11, 19,
in transverse plane;
20].
(b) the joint related to the trunk flexionextension
A triaxial trunk dynamometer was fabricated on
in the sagittal plane;
the basis of the design concept discussed above with
(c) the joint related to the trunk lateral bending in
special care to ensure proper adjustment of the
the coronal plane (Fig. 1).
mechanical parts and concurrency of the three main
Some additional features were also included in the joints (Fig. 2). Mechanically, the system consisted of
design to improve its performance. The foot pedestal three main links: a thoracic pad with straps to fasten
and thoracic pad could slide on prismatic joints to the thorax to the third link, pelvis pads with straps to
accommodate different body sizes and to adopt fasten the pelvis and limit its tilting motions, and a
different seated and standing postures. foot pedestal. Behind the thoracic pad, two linear
To ensure the efficacy of the design, some guides were used to allow for the spine deformity as
prefabrication analyses were conducted. A kinematic it deviated from neutral posture and to adjust the
model was developed and analysed using Visual pad for safe and comfort accommodation of differ-
Nastran (MSC Software Corporation, Santa Ana, ent body postures. The foot pedestal could also be
California, USA) to check the functionality of the adjusted using a manual hydraulic cylinder to fit the
designed mechanism and its range of motion in body anthropometry and posture. A hydraulic lock-
combined movements. Results indicated that the ing system (IranKhodro Co., Tehran, Iran) was used
links of the mechanism do not collide within their to lock the mechanism at the desired body posture.
specified range of motion and could accommodate To balance the device and to nullify the weights
anthropometry characteristics of the middle 90 per borne by the subject when the locks were opened,
cent of the intended population [25]. A finite appropriate deadweights were added to the tips of
element model was also developed and analysed the middle link.
using ANSYS 5.4 (ANSYS Inc., Canonsburg, Pennsyl- Three uniaxial torque TCN-50K sensors (Dacell
vania, USA) to check the extent of the device Co., Chung-buk, Republic of Korea) were installed at
deformations under applied loads. Results indicated the joints between the main links to measure the

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758 M R Azghani, F Farahmand, A Meghdari, G Vossoughi, and M Parnianpour

effector of the mechanism (equivalent to the forces

and moments in the subjects trunk about the L5S1
joint) to be related to the torques measured by the
torque sensors through a Jacobian matrix according
to
0 1
t1
B C
B t2 C
@ A
t3
0 1
0 0 0 sin h2 cos h3 {sin h2 sin h3 {cos h2
B C
~B
@0 0 0 sin h3 cos h3 0 C
A
0 0 0 0 0 1
0 1
Fx
B C
B Fy C
B C
B C
B Fz C
B C
|B C 1
(1)
B Mx C
B C
B C
B My C
@ A
Mz

where t1, t2, and t3 are the device joint torques

measured by torque sensors, Fx, Fy, and Fz are the
force components in the subjects trunk at the L5S1
level, Mx, My, and Mz are the moments in the
Fig. 2 An illustration of the in-vivo experiments with subjects trunk about the L5S1 joint, and h1, h2, and
the subject exerting extension moment while h3 are the device joint angles. In the neutral position
positioned at 15u right axial rotation, 35u of the device, accommodating the subject in the
flexion, and 15u left lateral bending. In real test upright posture, the joint angles were defined as
conditions the subjects had worn only swim- h1 5 0, h2 5 p/2, and h3 5 p/2.
ming shorts to minimize the slippage between
Considering the fact that the left half of the
the body and device interfaces
Jacobian matrix is null, as a result of the concurrency
of the device joint axes, equation (1) may be reduced
torque components; two self-aligning bearings were
to
used for each sensor to ensure that a pure torsional
moment is applied. The electronic part of the sys- 0 1 0 1
t1 sin h2 cos h3 {sin h2 sin h3 {cos h2
tem also included three NOC-S360-2MHc rotary en- B C B C
B t2 C~B sin h3 cos h3 0 C
coders (Nidec Nemicon Corp., Tokyo, Japan) for @ A @ A
recording the rotation angle of the main joints, a t3 0 0 1
16-channel electromyography (EMG) device (KYA 0 1
Co., Tehran, Iran), an in-house analogue amplifier Mx
B C
based on an AD624, a PCI-1710, and a PCI-1784 |B C
@ My A 2
analogue-to-digital converter (Advantech Co., Tai-
Mz
pei, Taiwan), and a personal computer. The data
acquisition system could record data with a fre-
and with a matrix inversion to
quency of up to 1000 Hz and was synchronized with
the EMG recording system. The whole system was 0 1 0 cos h3 cos h2 cos h3 10 1
Mx sin h2 sin h3 sin h2 t1
integrated using in-house software. B C B CB C
In order to resolve the measured torques and to @ My A~@ {sin h3 sin h2 cos h3 {cos h2 sin h3
sin h2
A@ t2 A 3
obtain the lumbar moments at three anatomical Mz 0 0 1 t3
planes, a DenavitHartenberg definition of the joint
coordinate system of the mechanism was formulated It is to be noted that the moments given by equation
[26]. This allowed the forces and moments at the end (3) are defined in a coordinate system attached to

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 Trunk muscle strength measurement system
the third link of the device, or equivalently the trunk.
Therefore, the above equation might be directly used
to obtain the lumbar moments in the anatomical
planes, as is desirable for clinical use.
2.2 Calibration and tests
In order to calibrate the device, a black-box
approach was employed. A linear relationship was
considered between the output signals of the torque
sensors and the joint torques, based on a primary
investigation [27], and the least-squares linear reg-
ression analysis was used to investigate the relation-
ship between a set of known loads and torques
measured. The optimal gain and offset of the sys-
tem were obtained by minimizing the measurement
error according to
0 1
X vestigated by applying pure torsional loads to each
min@ error2 A
gain, offset
hX
2 i
~min Tapplied {Tmeasured
|Tmeasured ~gain|Voutput zoffset
A special fixture and standard deadweights were
used for application of known loads to the system at
its standard position, with the joints adapted to an
upright body posture. At each loading course, the
loads were gradually increased and then decreased
to zero in six to nine steps, so that the hysteresis
effects could also be analysed. The maximum loads
were chosen according to the literature [10, 11, 19,
20], including 300 N m, 105 N m and 100 N m in the
sagittal, the coronal, and the axial directions respec-
tively. For each joint, the loading procedure was
conducted at both clockwise (CW) and counter-
clockwise (CCW) directions, with the joint locks
released between each two loading courses to
remove the effects of residual friction. The voltage
output of the three sensors was recorded for 3048
observation points, during each of the CW and CCW
loading courses of each joint. They were then
compared with the actually applied loads using
linear regression analyses in Microsoft Excel 2003
(Microsoft Inc., Redmond, Washington, USA) to
obtain the optimal gains and offsets.
In order to validate the above regression model,
another set of loading and unloading courses were
applied to the device with a similar procedure,
including 45 observation points distributed over
the full range of the load capacity of the system
(similar to the calibration procedure). The differ-
JEIM537 F IMechE 2009
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759
ences between the applied torques and the torques
calculated using the regression model were then
statistically analysed for each of the three torque
sensors in terms of the mean absolute error (MAE),
the r.m.s. error (RMSE), and the percentage of error.
Furthermore, the minimum detectable change
(MDC) of the system was determined to identify
the device resolution, i.e. the smallest significant
difference that can be observed by the measurement
system. The standard error of measurement (SEM)
was also determined for these observations.
Some other experiments were also conducted by
loading the system with known deadweights to
investigate its accuracy and reliability. The trial-to-
trial variability of the device was analysed at six
observation points of each of the five different trials
for each of the CW and CCW loading courses of each
joint. The cross-talk between the sensors was in-
of the transverse, sagittal, and coronal axes of the
device separately and recording the triaxial response
at the device sensors.
The performance of the system was then assessed
4 in a number of in-vivo tests on normal subjects
(Fig. 2). 30 healthy males (age, 25( 2.5 standard
deviation (SD)) years; mass, 74 ( 5.6 SD) kg) with
no history of low-back pain in the previous year
participated in this study. Prior to testing, all
participants read and signed an informed consent
form approved by the universitys Human Investiga-
tions Committee. During the tests, the subjects,
wearing only swimming shorts, were positioned and
adjusted in the device so that they were tightly but
comfortably strapped in an upright position and
their L5S1 joints coincide with the reference point
(the intersection point of the joint axes) of the
device. The subjects were then instructed to perform
maximal voluntary exertion (MVE) randomly in the
cardinal directions. 12 trials were taken from each
subject including two trials for each of the flexion
extension, leftright lateral bending, and leftright
axial rotation exertions. Each trial continued for 7 s
with a 2 min rest period between trials to prevent
muscular fatigue.
The joint torque and angular configuration data
were collected at a frequency rate of 100 Hz during
the whole interval while the subjects were asked and
encouraged verbally to exert with their full capacity
in the intended direction. From the recorded data,
the most stable subinterval of 3 s was used in the
analyses [19, 28, 29]. To establish the reliability of
the in-vivo experiments, for all subjects the trial-to-
trial variability of the maximum moments measured
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760 M R Azghani, F Farahmand, A Meghdari, G Vossoughi, and M Parnianpour

Table 1 Results of the validation analysis of the regression model for each of the joints torque cells (the
abbreviations are defined in the text)
Joint Plane Loading direction MAE (N m) RMSE (N m) SEM (N m) MDC (N m)
1 Transverse CCW 1.64 1.88 0.33 0.92
CW 0.42 0.48 0.33 0.91
2 Sagittal CCW 0.92 1.29 0.52 1.43
CW 0.67 0.81 0.58 1.62
3 Coronal CCW 0.39 0.43 0.15 0.42
CW 0.13 0.16 0.20 0.56

in each of the six directions were compared
statistically and the intra-class correlation coefficient
(ICC2,1), SEM, percentage of error, and paired t-test
[30] were assessed using SPSS (SPSS Inc. Chicago,
Illinois, USA).
3 RESULTS
The R2 results for the optimal offset and gain
parameters of the system obtained during the
calibration procedure for CW and CCW loading
courses of all joints were between 0.998 and 1. The
results of the validation analysis of the regression
model using deadweights are illustrated in Table 1.
The MAE and RSME results indicated that the
highest errors were observed in the CCW loading of
the transverse and sagittal plane joints with magni-
tudes of less than 2 per cent of the applied load. For
the coronal plane joint and CW loading courses of
the other joints, the measurement errors were always
of less than 1 per cent of the applied load. The SEM
and MDC results, on the other hand, indicated that
the MDC of the joint torques for the transverse and
coronal plane joints were less than 1 N m. The lowest
resolution of torque measurement was observed in
the sagittal plane joint, with magnitudes of 1.43 N m
and 1.62 N m for CCW and CW loading courses
respectively.
The results of the trial-to-trial variability analysis
of the system using deadweights indicated that
ICC2,1 for CW and CCW loading courses of all joints
was between 0.9998 and 1. The results of the cross-
talk analysis of the system by applying pure torsional
loads to each of its three axes are shown in Table 2.
The highest cross-talks were observed when the
system was subjected to pure flexionextension or
lateral bending torques. Under 203 N m flexion to
220 N m extension loadings, the resulting cross-talks
were obtained to be between 21.5 N.m and 2.8 N m
in the transverse plane joint, and between 23.5 N m
and 2.6 N m in the coronal plane joint. Also loading
the system with 74 N m pure left and right lateral
bending torques produced cross-talks as high as
2.5 N m and 1 N m in the transverse and sagittal
plane joints respectively. The least cross-talks were
observed under pure torsional loading with magni-
tudes of 0.6 N m and 0.4 N m in the sagittal and
coronal plane joints respectively, when the system
was subjected to 90 N m axial torque.
The representative curves of joint torques against
time for one of the subjects of this study during an
extension exertion trial in the upright position are
shown in Fig. 3. As expected, the main torque
observed during these experiments was the exten-
sion torque which increased gradually from zero to a
maximum of about 160 N m. A small increasing right
lateral bending torque with a maximum of 22.1 N m,
however, was also recorded by the coronal plane
joint sensor due to the coupling effects. In general,
there was good agreement between the torque
measurement data during the two trials for all joints.
More specifically, the behaviour and the maximum
torques of the two trials during their most stable 3 s
subinterval were close (Table 3).
The results of the trial-to-trial variability analysis
of the system during in-vivo strength measurement
tests of all subjects are shown in Table 3. Statistical
comparison of the maximum torques for the six
directions resulted in the ranges of ICC2,1, SEM, and
percentage of error of 0.690.91, 7.423.9 N m, and
7.310.5 per cent respectively. The strength values

Table 2 Results of the cross-talk analysis of the device sensors (the maximum values are shown in bold)
Range of the torque variation in the joint (N m)
Joint Direction of the applied torque Coronal plane Sagittal plane Transverse plane
1 Axial rotation (transverse plane) 290 to 90 20.6 to 0.6 20.4 to 0.4
2 Flexionextension (sagittal plane) 21.5 to 2.8 2203 to 220 23.5 to 2.6
3 Lateral bending (coronal plane) 22.5 to 2.5 21 to 1 274 to 74

Sign definition: clockwise, 2; counterclockwise, +.

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 Trunk muscle strength measurement system 761

Fig. 3 The representative curves of joint torques against time for a subject during extension
exertion in the upright position

were not significantly different (p > 0.07) between
the two trials.
Table 4 represents the means and SDs of the
maximum triaxial torques observed for the whole
population tested (n 5 30) at the erect position. The
largest torques were observed in the extension and
flexion directions with means of 134.4 (0.55 SD)
N m and 114.4 (0.55 SD) N m respectively. For right
and left lateral bending, the means of maximum
torques were obtained to be 132.0 (0.17 SD) N m
and 118.0 (0.17 SD) N m respectively. The smallest
torques were observed for attempted left and right
axial rotations with means of maximum torques of
57.0 (0.33 SD) N m and 57.3 (0.33 SD) N m
respectively. In all tests, in spite of the subjects
intention to apply torque in one direction only, load
exertion in the other two anatomical directions was
also observed. These coupling effects were relatively
small in flexionextension exertion with magnitudes
of less than 9.9 per cent and 5.9 per cent of the main
torques, in transverse and coronal planes respec-
tively. A relatively large coupling, however, was
observed between the exertions in axial and coronal
planes. During left rotation exertion, the resulting
coupling moment in the coronal plane was as high
as 42 per cent of the main axial torque.
4 DISCUSSION
The maximal strength measurement of the trunk
has been used to estimate the risk of developing
musculoskeletal injuries in work situations with
mixed results in epidemiological studies [3133]. In
general, the measurement can be conducted using
dynamic or isometric protocols; the trunk isometric
strength measurement systems are usually preferred
over the dynamic systems for being safer, simpler,
and less expensive [34, 35]. Several isometric trunk
strength measurement devices have been introduced
and used in previous in-vivo investigations [1117,
19, 20]. The system developed in the present study is
believed to provide a superior performance over the
existing devices with the significant capability of
isometric trunk strength measurement at any asym-
metric posture while validly resolving the moment

Table 3 Results of the reliability analysis of the system in terms of intra-class ICC2,1, SEM, and the p value of the
paired t test (n 5 30)
Exertion ICC2,1 SEM (N m) Percentage of error (%) p value (paired t test)
Flexion 0.76 23.9 10.9 0.725
Extension 0.90 17 8.3 0.699
Left lateral bending 0.69 20.6 10.6 0.532
Right lateral bending 0.86 16.1 7.9 0.079
Left rotation 0.91 7.4 7.3 0.959
Right rotation 0.84 7.9 8.4 0.077

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762 M R Azghani, F Farahmand, A Meghdari, G Vossoughi, and M Parnianpour

Table 4 The means (SDs in parentheses) of the maximum triaxial isometric trunk moments of 30 healthy males at
the L5S1 joint in six cardinal directions in the upright posture. The maximum isometric trunk moments
produced during different exertions are shown in bold
Mean (SD) maximum triaxial moment (N m)
Exertion Axial moment Mx (N m) Sagittal moment My (N m) Coronal moment Mz (N m)
Flexion 26.7 (6.8) 2114.4 (37.2) 211.3 (10.7)
Extension 7.9 (6.4) 134.4 (43.4) 21.3 (8.5)
Left lateral bending 9.4 (6.2) 10.4 (15) 118 (29)
Right lateral bending 26.9 (9.4) 214.1 (16.8) 2132 (30)
Left rotation 257 (17) 212 (27.4) 224 (22)
Right rotation 57.3 (13) 12.6 (19) 12.6 (20.4)

Sign definition: flexion, 2; extension, +; left lateral bending, +; right lateral bending, 2; left rotation, 2; right rotation, +.

generated by trunk muscles in the three anatomic
planes.
The capabilities of the system are partly achieved
through the concurrency of its axes, which elim-
inates the inherent error in torque measurements
and provides a simple transformation relationship
between the device and trunk coordinate systems.
Equation (3) signifies the relationship between the
torques measured by device sensors and the trunk
torques around the L5S1 joint in accordance with
the ISB recommendation for definition of the joint
coordinate system [21]. This equation is indetermi-
nate only when the sagittal plane joint (related to
flexionextension) rotates 90u, which is well out of
the practical range of motion of the device. This
device allows from ranges of motion in the sagittal,
coronal, and transverse planes from 245u to 45u,
from 75u to 245u, and from 230u to 30u respectively.
Moreover, with the separation of the locking
system from the measurement system, a large
feasible region of symmetric and asymmetric posi-
tions is made accessible for isometric strength tests.
This is an important advantage over the existing
devices such as the B200 system which has been
suggested to provide valid axial measurements only
in the upright position, because of its gimbals
system design and arrangement of the chest restraint
[19, 36]. The significance of the body posture in the
results of the trunk strength measurements has been
well documented in the biomechanics literature [29,
31, 36]. It has also been shown that not only the
trunk motion but also the trunk torques are coupled
in the three anatomical plans, i.e. the lumbar
muscles often produce moments in more than one
anatomical plane when activated [28, 36, 37]. This
coupling effect is thought to be due to the bony
architecture of the spine, the anatomy and laxity of
the ligamentous structures, and more importantly
the overlapping anatomical configuration of the
lumbar muscles. A distinctive example is the coup-
ling between the axial rotation and lateral bending
due to the spines curvature in the sagittal plane
and lack of pure axial rotator muscles in the spine
[19, 36, 38, 39]. These observations highlight the
importance of recording the coupling effects of
muscle activation in asymmetric positions, as well
as the neutral posture, by triaxial measurement
systems [39, 40].
A basic limitation of the system in its present
design is the fact that it is only capable of working in
the isometric strength-testing mode. Although most
of the currently available biomechanical strength
models of the trunk are based on static maximum
strength measurements, in real-life work situations,
individuals rarely exert lengthy or maximum static
efforts [36]. The low-inertia configuration of our
system, however, allows it to be further developed in
future to function in dynamic operating modes, e.g.
isokinetic, isoresistive, and isodynamic muscle ac-
tions.
Another limitation of our system, and other similar
devices, is the non-rigid attachment of the subjects
body to the system. Use of straps tightened on the
subjects bare trunk has been the only effective
solution so far [15, 41] which obviously results in
slippage between the strap and skin surfaces if the
necessity for the subjects comfort is acknowledged.
This can cause a considerable error in the measure-
ment of both the body movement and the trunk
torques during dynamic tests. However, for an iso-
metric strength-testing system, such as the present
system, only a limited error might be caused in the
measurement of the body position but not in the
measurement of the trunk torques.
A comprehensive set of calibration experiments
was conducted on the system using deadweights to
obtain its optimal gains and offsets based on a linear
regression model. The R2 results of calibration for all
loading courses of all joints were higher than 0.99
which indicated an excellent linear correlation
between the output voltage of the sensors and
applied torques and suggested that the optimal gain

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 Trunk muscle strength measurement system 763

and offset parameters obtained during the calibra-
tion procedure might be effectively used for torque
measurement tests. The results of the validation
analysis of the regression model (Table 1) suggested
that the MAE and the RMSE were highest for the first
joint (transverse plane) and least for the third joint
(coronal plane). This is not surprising considering
the fact that, with increasing distance from the load
application site in thoracic pad, the effect of error
sources, e.g. link deformation and joint laxity, is
enhanced and the resulting errors are accumulated.
The overall errors, however, were obtained to be
reasonable with the highest magnitude of less than 2
per cent of the applied load. For the MDC, there was
another important component besides the above
factors, i.e. the full-scale load, which strongly
affected the measurement resolution. As a result,
the maximum value of MDC was observed for the
sagittal plane joint which had the highest full-scale
load of 300 N m. The overall MDCs for different
joints, however, were again acceptable with the
lowest magnitude of 0.8 per cent of the applied load.
The other validation tests using deadweights, i.e.
trial-to-trial variability and cross-talk analysis, also
returned reasonable results. The trial-to-trial varia-
bility of the device characterized with ICC2,1 was
obtained to be higher than 0.99 which suggests an
excellent reliability. The cross-talk analysis of the
device indicated maximum cross-talks of 1.7 per
cent and 3.4 per cent when the system was subjected
to flexionextension and lateral bending torques
respectively. These are reasonably acceptable if the
very large coupling effects between trunk torques
observed during in-vivo tests are considered. No
such detailed analysis has been provided for other
devices in use in the existing literature.
The trial-to-trial variability of the system during
in-vivo strength measurement tests was analysed
using different statistical measures (Table 3). Results
indicated that there was no significant difference
between the maximum moments of each two
relevant trials. The systems reliability appeared to
be good to excellent, with ICC2,1 from 0.69 to 0.91.
Similar reliability results have been reported pre-
viously [39, 42]; however, this study was the first in
which detailed reliability data were provided for both
the device and the human performance using the
device.
The results of the MVE measurements of the trunk
obtained for the 30 subjects of the present study
were well within the range of the previously pub-
lished data in the literature (Table 5). The differen-
ces may be attributed to the different testing devices
and protocols, as well as the testing populations.
Moreover, the coupling behaviour of the spine dur-
ing isometric trunk tests, observed in the present
study, has been similar to what was described in
previous investigations [19, 36]. The results obtained
for the lateral bending and rotation accessory
torques of less than 5.8 per cent and 9.9 per cent
respectively of the primary extension torque are
comparable with the 5 per cent and 16 per cent
results, reported by Tan et al. [37] and Parnianpour
and co-workers [19, 36]. Also, the stronger coupling
between axial rotation and lateral bending torques
observed in the present study (Table 4) is consistent
with that reported by Parnianpour et al. [36].
The extensive capabilities and high reliability of
the system developed in the present study are
promising for more comprehensive investigations
on trunk biomechanics in future. The isometric
strength measurement tests of the trunk could be

Table 5 The means (SDs in parentheses) of the maximum isometric trunk moments about L5S1 as reported in the
literature
Mean (SD) of the maximum isometric trunk moment (N m)
Number and sex of Right lateral Left lateral
Reference subjects Flexion Extension bending bending Right rotation Left rotation
Lariviere et al. [10] 14 males 251 (51)
Lee and Kuo [11] 71 males 109 (30.2) 150 (39.3) 122 (28.5) 123 (30.1) 62 (18.2) 55 (16.8)
Lee and Kuo [11] 79 females 43 (14.1) 75 (26.4) 59 (15.1) 63 (18.3) 32 (13.4) 24 (14)
Parnianpour et al. [19] 20 males 198 (55) 200 (46) 166 (36) 149 (45) 98 (32) 94 (34)
McNeill et al. [20] 27 males 149 210 151 143
McNeill et al. [20] 30 females 87 117 80 78
Parnianpour et al. [22] 9 males 160 (46) 126 (40) 107 (41)
Kumar [41] 59 males 194 (63) 321 (138) 165 (41) 162 (40) 81 (27) 79 (26)
Kumar [41] 43 females 114 (34) 185 (85) 117 (32) 101 (33) 45 (14) 42 (16)
Mclntyre et al. [43] 9 males and 7 females 111 (54.5) 153 (46.8) 124 (39.4) 127 (43.0) 79 (30.9) 73 (27.7)
Malchaire and Masset 393 males 138 (44.3) 166 (43.6) 146 (34.8) 147 (34.9) 71 (22.4) 74 (21.6)
[44]
Present study 30 males 114.35 (37.2) 134.4 (43.4) 132 (30) 118 (29) 57.3 (13) 57 (17)

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764 M R Azghani, F Farahmand, A Meghdari, G Vossoughi, and M Parnianpour
conducted in any symmetric and asymmetric pos-
tures in both seated and standing positions to enrich
the existing data concerning the trunk muscle
strength. Furthermore, more sophisticated experi-
ments using supplementary instruments, e.g. EMG
and intra-abdominal pressure gauges, can be per-
formed to study the effects of other factors that
determine the trunk biomechanics, e.g. the spinal
loading [45], endurance measurement [46], muscle
recruitment during tracking tasks [38] and the role
of internal abdominal pressure in stabilizing and
unloading of the spine [47, 48]. Some potential
clinical applications for diagnosis and treatment of
the LBD patients might also be considered for the
system. With the accurate measurement of the
coupled torques, the excessive coupled efforts of a
subject with suspected pathologies or impairment
might be used as an indicator of pain or protective
strategies. Also, a tracking mode can be implemen-
ted within the device in which the joints are locked
and the subject is asked to alter dynamically his or
her muscle recruitment to produce trunk torques
that follow a prescribed pattern, as shown graphi-
cally on a monitor. Such a system is expected to be
extremely useful for rehabilitation and selective
strengthening of the trunk muscles [38, 39, 49].
ACKNOWLEDGEMENTS
The help of Mr Feras Hakkak and Mr Javad Khamse
in the design and development of the system, and
Mrs Roya Narimani, Dr Javad Mousavi, and the staff
of the Biomechanics Laboratory in conducting the
experiments is appreciated. This study was sup-
ported in part by Grant 86034/15 from the Iran
National Science Foundation, the Center of Excel-
lence in Design, Robotics, and Automation, and The
Research Deputy of the Ministry of Industry and
Mines.
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