Back endurance is a strong predictor of back pain, but the mechanisms underlying this relationship are not clear. Fatigue reduces muscles' force-generating capacity, so greater fatigability may increase lumbar motion and loading and trunk muscle co-contraction. Using a novel pack to modify inertia, we tested the effect of back fatigue and increased trunk inertia on lumbar kinematics, kinetics and muscle activity during walking. Lumbar kinematic and kinetic amplitudes and maximum muscle activity were measured per stride across four conditions: pre- and post-fatigue, with and without increased trunk inertia. The pack caused increases in maximum lumbar erector spinae (ES) activity by 3.19 times the average value calculated during the pre-fatigue no-pack trial (P<0.001), amplitude of lumbar flexion-extension moment by 0.0189 N m (kg g m)-1 (P<0.001), lumbar lateral bending moment by 0.0028 N m (kg g m)-1 (P=0.019) and lumbar axial rotation moment by 0.0203 N m (kg g m)-1 (P<0.001), and decreases in the amplitude of roll angle by 1.31 deg and yaw angle by 6.65 deg (both P<0.001). Back endurance is positively associated with change in maximum lumbar ES activity (r=0.69, P=0.013) and negatively associated with change in maximum rectus abdominus (RA) activity (r=-0.72, P=0.008) and lumbar flexion-extension moment amplitude (r=-0.62, P=0.031). Overall, individuals with less back endurance had increased maximum RA activity and sagittal kinetics post-fatigue whereas individuals with higher back endurance showed the opposite response. Increased RA activity with less back endurance may be a protective mechanism for stabilizing the trunk in response to increased sagittal lumbar loading due to fatigue.

Optical motion capture (OMC) is considered the best available method for measuring spine kinematics, yet inertial measurement units (IMU) have the potential to collect data outside the laboratory. When combined with musculoskeletal modeling, IMU technology may be used to estimate spinal loads in real-world settings. To date, IMUs have not been validated for estimates of spinal movement and loading during both walking and running. Using OpenSim Thoracolumbar Spine and Ribcage models, we compare IMU and OMC estimates of lumbosacral (L5/S1) and thoracolumbar (T12/L1) joint angles, moments, and reaction forces during gait across six speeds for five participants. For comparisons, time series are ensemble averaged over strides. Comparisons between IMU and OMC ensemble averages have low normalized root mean squared errors (< 0.3 for 81% of comparisons) and high, positive cross-correlations (> 0.5 for 91% of comparisons), suggesting signals are similar in magnitude and trend. As expected, joint moments and reaction forces are higher during running than walking for IMU and OMC. Relative to OMC, IMU overestimates joint moments and underestimates joint reaction forces by 20.9% and 15.7%, respectively. The results suggest using a combination of IMU technology and musculoskeletal modeling is a valid means for estimating spinal movement and loading.

Over the course of the physical activity transition, machines have largely replaced skeletal muscle as the source of work for locomotion and other forms of occupational physical activity in industrial environments. To better characterize this transition and its effect on back muscles and the spine, we tested to what extent typical occupational activities of rural subsistence farmers demand higher magnitudes and increased variability of back muscle activity and spinal loading compared to occupational activities of urban office workers in Rwanda, and whether these differences were associated with back muscle endurance, the dominant risk factor for back pain. Using electromyography, inertial measurement units, and OpenSim musculoskeletal modeling, we measured back muscle activity and spinal loading continuously while participants performed occupational activities for one hour. We measured back muscle endurance using electromyography median frequency analysis. During occupational work, subsistence farmers activate their back muscles and load their spines at 390% higher magnitudes and with 193% greater variability than office workers. Partial correlations accounting for body mass show magnitude and variability response variables are positively associated with back muscle endurance (R = 0.39-0.90 [P < 0.001-0.210] and R = 0.54-0.72 [P = 0.007-0.071], respectively). Body mass is negatively correlated with back muscle endurance (R = -0.60, P = 0.031), suggesting higher back muscle endurance may be also partly attributable to having lower body mass. Because higher back muscle endurance is a major factor that prevents back pain, these results reinforce evidence that under-activating back muscles and under-loading spines at work increases vulnerability to back pain and may be an evolutionary mismatch. As sedentary occupations become more common, there is a need to study the extent to which occupational and leisure time physical activities that increase back muscle endurance helps prevent back pain.

We examined the effects of vertical load placement on the metabolic cost of walking. Twelve healthy participants walked on a treadmill with 13.8 and 23.4 kg loads in both high and low vertical positions. Metabolic rate was measured using respirometry. While load position had no effect on the net metabolic rate for the 13.8 kg load, the net metabolic rate with the 23.4 kg load was significantly reduced by 4.3% in the high vertical load position compared to the low vertical load position. Loads carried higher on the trunk were also associated with increased forward trunk lean that reduced the load gravitational moment arm in the sagittal plane suggesting that reduction of fore-aft upper body torques is an energy-saving mechanism during loaded walking. Practitioner Summary: Load placement within a backpack affects the biomechanics of load carriage. We experimentally tested the metabolic cost of high and low load placement during walking and found the high position to be less costly with large loads. Loading high may be the optimal technique for carrying heavy backpacks.

Humans differ from African great apes in numerous respects, but the chief initial difference setting hominins on their unique evolutionary trajectory was habitual bipedalism. The two most widely supported selective forces for this adaptation are increased efficiency of locomotion and improved ability to feed in upright contexts. By 4 million years ago, hominins had evolved the ability to walk long distances but extreme selection for endurance capabilities likely occurred later in the genus Homo to help them forage, power scavenge and persistence hunt in hot, arid conditions. In this review we explore the hypothesis that to be effective long-distance walkers and especially runners, there would also have been a strong selective benefit among Homo to resist fatigue. Our hypothesis is that since fatigue is an important factor that limits the ability to perform endurance-based activities, fatigue resistance was likely an important target for selection during human evolution for improved endurance capabilities. We review the trade-offs between strength, power, and stamina in apes and Homo and discuss three biological systems that we hypothesize humans evolved adaptations for fatigue resistance: neurological, metabolic and thermoregulatory. We conclude that the evolution of endurance at the cost of strength and power likely also involved the evolution of mechanisms to resist fatigue.

Like other animals, humans use their legs like springs to save energy during running. One potential contributor to leg stiffness in humans is the longitudinal arch (LA) of the foot. Studies of cadaveric feet have demonstrated that the LA can function like a spring, but it is unknown whether humans can adjust LA stiffness in coordination with more proximal joints to help control leg stiffness during running. Here, we used 3-D motion capture to record 27 adult participants running on a forceplate-instrumented treadmill, and calculated LA stiffness using beam bending and midfoot kinematics models of the foot. Because changing stride frequency causes humans to adjust overall leg stiffness, we had participants run at their preferred frequency and frequencies 35% above and 20% below preferred to test for similar adjustments in the LA. Regardless of which foot model we used, we found that participants increased LA quasi-stiffness significantly between low and high frequency runs, mirroring changes at the ankle, knee and leg overall. However, among foot models, we found that the model incorporating triceps surae force into bending force on the foot produced unrealistically high LA work estimates, leading us to discourage this modeling approach. Additionally, we found that there was not a consistent correlation between LA height and quasi-stiffness values among the participants, indicating that static LA height measurements are not good predictors of dynamic function. Overall, our findings support the hypothesis that humans dynamically adjust LA stiffness during running in concert with other structures of the leg.

OBJECTIVES:High trunk muscle endurance, strength, and moderate flexibility reportedly help maintain musculoskeletal health, but there is evidence for tradeoffs among these variables as well as sex differences in trunk muscle endurance and strength. To test if these observations extend similarly to both men and women in nonindustrial and industrial environments, we investigated intra-individual associations and group and sex differences in trunk muscle endurance, strength, and flexibility among 74 (35 F, 39 M; age range: 18-61 years) adults from the same Kalenjin-speaking population in western Kenya. We specifically compared men and women from an urban community with professions that do not involve manual labor with rural subsistence farmers, including women who frequently carry heavy loads.METHODS:Trunk muscle endurance, strength, and flexibility were measured with exercise tests and electromyography (EMG).RESULTS:We found a positive correlation between trunk extensor strength and endurance (R = .271, p ≤ .05) and no associations between strength or endurance and flexibility. Rural women had higher trunk extensor and flexor endurance, EMG-determined longissimus lumborum endurance, and trunk extensor strength than urban women (all p ≤ .05). Rural women had higher trunk extensor and flexor endurance than rural men (both p ≤ .05). Urban women had lower trunk flexor and extensor endurance than urban men (both p ≤ .01).CONCLUSIONS:High levels of physical activity among nonindustrial subsistence farmers, particularly head carrying among women, appear to be associated with high trunk muscle endurance and strength, which may have important benefits for helping maintain musculoskeletal health.