Spine stability: Lessons from balancing a stick


      This paper introduces control concepts that are important for ensuring stability. To clarify these concepts, a series of experiments using a simple task of stick balancing will be performed. The lessons from these experiments will be applied to the spine system and illustrated with clinical examples. Insight into the following will be gained: what information is used to stabilize the spine, how does noise in control affect spine performance, how has the spine evolved to allow it to be stabilized and controlled in a metabolically efficient way, how do delays in control affect spine performance, and how do different goals (i.e., maximizing performance versus minimizing fatigue) affect the logic for controlling the spine?


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        • Asell M.
        • Sjölander P.
        • Kerschbaumer H.
        • Djupsjöbacka M.
        Are lumbar repositioning errors larger among patients with chronic low back pain compared with asymptomatic subjects?.
        Arch. Phys. Med. Rehabil. 2006; 87: 1170-1176
        • Brumagne S.
        • Cordo P.
        • Lysens R.
        • Verschueren S.
        • Swinnen S.
        The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain.
        Spine. 2000; 25: 989-994
        • Buxton D.F.
        • Peck D.
        Neuromuscular spindles relative to joint complexities.
        Clin. Anat. 1989; 2: 211-224
        • Cholewicki J.
        • McGill S.M.
        Lumbar posterior ligament involvement during extremely heavy lifts estimated from fluoroscopic measurements.
        J. Biomech. 1992; 25: 17-28
        • Cholewicki J.
        • Silfies S.P.
        • Shah R.A.
        • Greene H.S.
        • Reeves N.P.
        • Alvi K.
        • et al.
        Delayed trunk muscle reflex responses increase the risk of low back injuries.
        Spine. 2005; 30: 2614-2620
        • Descarreaux M.
        • Blouin J.S.
        • Teasdale N.
        Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects.
        Eur. Spine J. 2005; 14: 185-191
        • Field E.
        • Abdel-Moty E.
        • Loudon J.
        The effect of back injury and load on ability to replicate a novel posture.
        J. Back Musculoskelet. Rehabil. 1997; 8: 199-207
        • Gill K.P.
        • Callaghan M.J.
        The measurement of lumbar proprioception in individuals with and without low back pain.
        Spine. 1998; 23: 371-377
        • Hides J.A.
        • Richardson C.A.
        • Jull G.A.
        Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.
        Spine. 1996; 21: 2763-2769
        • Hides J.A.
        • Stokes M.J.
        • Saide M.
        • Jull G.A.
        • Cooper D.H.
        Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain.
        Spine. 1994; 19: 165-172
        • Hodges P.W.
        • Moseley G.L.
        • Gabrielsson A.
        • Gandevia S.C.
        Experimental muscle pain changes feedforward postural responses of the trunk muscles.
        Exp. Brain Res. 2003; 151: 262-271
        • Houk J.C.
        • Rymer W.Z.
        • Crago P.E.
        Dependence of dynamic response of spindle receptors on muscle length and velocity.
        J. Neurophysiol. 1981; 46: 143-166
        • Koumantakis G.A.
        • Winstanley J.
        • Oldham J.A.
        Thoracolumbar proprioception in individuals with and without low back pain: intratester reliability, clinical applicability, and validity.
        J. Orthop. Sports Phys. Ther. 2002; 32: 327-335
        • Lam S.S.
        • Jull G.
        • Treleaven J.
        Lumbar spine kinesthesia in patients with low back pain.
        J. Orthop. Sports Phys. Ther. 1999; 29: 294-299
        • Lariviere C.
        • Gagnon D.
        • Loisel P.
        The comparison of trunk muscles EMG activation between subjects with and without chronic low back pain during flexion–extension and lateral bending tasks.
        J. Electromyogr. Kinesiol. 2000; 10: 79-91
        • Lee A.S.
        • Cholewicki J.
        • Reeves N.P.
        • Zazulak B.T.
        • Mysliwiec L.W.
        Comparison of trunk proprioception between patients with low back pain and healthy controls.
        Arch. Phys. Med. Rehabil. 2010; 91: 1327-1331
        • Leinonen V.
        • Kankaanpaa M.
        • Luukkonen M.
        • Kansanen M.
        • Hanninen O.
        • Airaksinen O.
        • et al.
        Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain.
        Spine. 2003; 28: 842-848
        • Leinonen V.
        • Maatta S.
        • Taimela S.
        • Herno A.
        • Kankaanpaa M.
        • Partanen J.
        • et al.
        Impaired lumbar movement perception in association with postural stability and motor- and somatosensory-evoked potentials in lumbar spinal stenosis.
        Spine. 2002; 27: 975-983
        • Luoto S.
        • Taimela S.
        • Hurri H.
        • Aalto H.
        • Pyykko I.
        • Alaranta H.
        Psychomotor speed and postural control in chronic low back pain patients A controlled follow-up study.
        Spine. 1996; 21: 2621-2627
        • Magnusson M.L.
        • Aleksiev A.
        • Wilder D.G.
        • Pope M.H.
        • Spratt K.
        • Lee S.H.
        • et al.
        European Spine Society—the AcroMed Prize for Spinal Research 1995. Unexpected load and asymmetric posture as etiologic factors in low back pain.
        Eur. Spine J. 1996; 5: 23-35
        • Marras W.S.
        • Davis K.G.
        • Maronitis A.B.
        A non-MVC EMG normalization technique for the trunk musculature: part 2. Validation and use to predict spinal loads.
        J. Electromyogr. Kinesiol. 2001; 11: 11-18
        • McGill S.
        Low Back Disorders: Evidence-based Prevention and Rehabilitation.
        Human Kinetics, Champaign, Ill.2002
        • Milton J.
        • Cabrera J.L.
        • Ohira T.
        • Tajima S.
        • Tonosaki Y.
        • Eurich C.W.
        • et al.
        The time-delayed inverted pendulum: implications for human balance control.
        Chaos. 2009; 19: 026110
        • Moseley G.L.
        • Nicholas M.K.
        • Hodges P.W.
        Does anticipation of back pain predispose to back trouble?.
        Brain. 2004; 127: 2339-2347
        • Nitz A.J.
        • Peck D.
        Comparison of muscle spindle concentrations in large and small human epaxial muscles acting in parallel combinations.
        Am. Surg. 1986; 52: 273-277
        • O'Sullivan P.B.
        • Burnett A.
        • Floyd A.N.
        • Gadsdon K.
        • Logiudice J.
        • Miller D.
        • et al.
        Lumbar repositioning deficit in a specific low back pain population.
        Spine. 2003; 28: 1074-1079
        • Radebold A.
        • Cholewicki J.
        • Panjabi M.M.
        • Patel T.C.
        Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain.
        Spine. 2000; 25: 947-954
        • Radebold A.
        • Cholewicki J.
        • Polzhofer G.K.
        • Greene H.S.
        Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain.
        Spine. 2001; 26: 724-730
        • Reeves N.P.
        • Cholewicki J.
        Expanding our view of the spine system.
        Eur. Spine J. 2010; 19: 331-332
        • Reeves N.P.
        • Cholewicki J.
        • Milner T.E.
        Muscle reflex classification of low-back pain.
        J. Electromyogr. Kinesiol. 2005; 15: 53-60
        • Reeves N.P.
        • Cholewicki J.
        • Narendra K.S.
        Effects of reflex delays on postural control during unstable seated balance.
        J. Biomech. 2009; 42: 164-170
        • Reeves N.P.
        • Narendra K.S.
        • Cholewicki J.
        Spine stability: the six blind men and the elephant.
        Clin. Biomech. 2007; 22: 266-274
        • Sanchez-Zuriaga D.
        • Adams M.A.
        • Dolan P.
        Is activation of the back muscles impaired by creep or muscle fatigue?.
        Spine. 2010; 35: 517-525
        • Silfies S.P.
        • Cholewicki J.
        • Reeves N.P.
        • Greene H.S.
        Lumbar position sense and the risk of low back injuries in college athletes: a prospective cohort study.
        BMC Musculoskelet. Disord. 2007; 8: 129
        • Teyhen D.S.
        • Flynn T.W.
        • Childs J.D.
        • Abraham L.D.
        Arthrokinematics in a subgroup of patients likely to benefit from a lumbar stabilization exercise program.
        Phys. Ther. 2007; 87: 313-325
        • Teyhen D.S.
        • Flynn T.W.
        • Childs J.D.
        • Kuklo T.R.
        • Rosner M.K.
        • Polly D.W.
        • et al.
        Fluoroscopic video to identify aberrant lumbar motion.
        Spine (Phila Pa 1976). 2007; 32: 220-229
        • van Dieen J.H.
        • Cholewicki J.
        • Radebold A.
        Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine.
        Spine. 2003; 28: 834-841
        • White A.A.
        • Panjabi M.
        Clinical Biomechanics of the Spine.
        Lippincott, Philadelphia1990
        • Wilder D.G.
        • Aleksiev A.R.
        • Magnusson M.L.
        • Pope M.H.
        • Spratt K.F.
        • Goel V.K.
        Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation.
        Spine. 1996; 21: 2628-2639