THE EFFECTS OF INTRA-ABDOMINAL

PRESSURE ON THE STABILITY AND UNLOADING

OF THE SPINE
HOSSEIN MOKHTARZADEH
*
,||
, FARZAM FARAHMAND
,
,
ABOULFAZL SHIRAZI-ADL

, NAVID ARJMAND

,
FATEMEH MALEKIPOUR
*
and MOHAMAD PARNIANPOUR
,
*
Department of Mechanical Engineering
The University of Melbourne
Victoria 3010, Australia

Department of Mechanical Engineering

Sharif University of Technology, Tehran, Iran

RCSTIM, Tehran University of Medical Sciences

Tehran, Iran

Division of Applied Mechanics, Department of Mechanical Engineering

Ecole Polytechnique, Montreal, Quebec, Canada

Department of Industrial and Management Engineering

Hanyang University, Ansan, Republic of Korea
||
mok@student.unimelb.edu.au
Received 1 December 2010
Revised 19 April 2011
Accepted 8 May 2011
In spite of earlier experimental and modeling studies, the relative role of the intra-abdominal
pressure (IAP) in spine mechanics has remained controversial. This study employs simple ana-
lytical and nite element (FE) models of the spine and its surrounding structures to investigate the
contribution of IAP to spinal loading and stability. The analytical model includes the abdominal
cavity surrounded by muscles, lumbar spine, rib cage and pelvic ring. The intra-abdominal cavity
and its surrounding muscles are represented by a thin deformable cylindrical membrane. Muscle
activation levels are simulated by changing the Youngs modulus of the membrane in the direction
of muscle bers, yielding IAP values recorded under the partial Valsalva maneuver. In the FE
model, the abdominal cavity is cylindrical and lled with a nearly incompressible uid. The
surrounding muscles are modeled as membrane elements with transverse isotropic material
properties simulating their ber orientation. Results indicate a goodqualitative agreement between
the analytical and FE models. Larger external force and/or higher levels of muscle activation
generate higher IAP thereby increasing spinal stiness. These eects are more pronounced for
activation of muscles with more horizontally directed bers, e.g., transverse abdominis (TA). The
capacity of the abdominal muscles to indirectly unload and stabilize the spine by generating IAP
depends mostly on their ber orientation, and secondarily on their cross-section area.
Keywords: Intra-abdominal pressure; nite element model; analytical model; abdominal
muscles; spine.
||
Corresponding author.
Journal of Mechanics in Medicine and Biology
Vol. 12, No. 1 (2012) 1250014 (21 pages)
c World Scientic Publishing Company
DOI: 10.1142/S0219519412004508
1250014-1
Nomenclature
Parameter Denition
A Diaphragms area
A
s
Spines cross sectional area
C
i
, D
i
Constants
E
s
Elasticity modulus of the spine
E
v
Elasticity modulus of muscular layer during partial Valsalva
maneuver
E
z
Elasticity modulus of muscular layer in vertical direction
E
0
Elasticity modulus of muscular layer in the ber direction
F
e
External force
F
s
Spinal force
I
xx
, I
yy
, I
zz
Spines moments of inertia about x, y, z axes
L Spinal upright length
M
s
Spinal moment at L1 level
P Intra-abdominal pressure (IAP)
R Radius of cavity cylinder
T Thickness of muscular layer
V
o
Initial cavity volume
V Variation of cavity volume after deformation
B Muscle activation ratio
u
f
Bulk modulus of intra abdominal cavity uids
c
d
Downward displacement of centre of diaphragm
c
l
Longitudinal deection of cavity cylinder
c
r
Radial deection of cavity cylinder

0
Strain of muscular layer in ber direction

z
Strain of muscular layer in vertical direction
i
xy
Poissons ratio of the spine
i
z0
Poissons ratio of muscular layer in vertical direction
i
0z
Poissons ratio of muscular layer in ber direction
o
0
Muscle tension at ber direction
o
z
Muscle tension at axial direction
RA Rectus abdominis
EOB External oblique
IOB Internal oblique
ES Erector spinae
LAT Latissimus dorsi
TA Transverse abdominis
H. Mokhtarzadeh
1250014-2
1. Introduction
Low back pain (LBP) is one of the most costly disorders diminishing productivity
and well being of the aected population. The LBP can be caused by injuries to any
of the spinal structures that have shown to be innervated and endowed with the
nocioceptors such as ligaments, endplate, annulus bers, muscles, facet joints and
capsules.
13
The mechanical pressure on the nerve roots due to disc prolapsed or
herniation and/or the chemical inammation in the presence of various neuro-
transmitters such as substance p can generate back pain.
1,4
The disc degeneration
can also lead to disruption in the disc structure, biochemical and physical properties
that can lead to discogenic LBP.
1,5,6
Epidemiological studies indicate that spine
disorders are the most prevalent cause of chronic disability in persons less than
45 years.
1
As many as 85% of adults experience LBP, and up to 25% of the people
between the ages of 3050 years report low back symptoms. A life time LBP
prevalence of up to 70% has been reported while 4%5% of the population
experiences an acute episode every year. Majority of all low back patients recover
within six weeks irrespective of the type of treatment but the remaining minority
($10%) who continue to become chronic after three months, or longer, account for
80% of disability costs. LBP is hence a major health problem in the industrialized
world and the occupational low-back disorders account for the most signicant
industrial musculoskeletal disorders (MSDs).
1
Although the cause of most LBDs remains unknown, but biomechanical and
psychological factors need to be taken into account for an adequate understanding
of the mechanism of LBP.
1
For the latter, monotonous work, high perceived
workload, time pressure, low control on the job and lack of social support have been
postulated.
7
As for the former factors, epidemiological studies have associated few
occupational factors with LBP symptoms; physically heavy work, static work
postures, frequent bending and twisting, lifting and sudden forceful incidents,
repetitive work and exposure to vibration.
8
In a large survey, lifting or bending
episodes accounted for 33% of all work-related causes of back pain.
9
Combination of
lifting with lateral bending or twisting that occurs in asymmetric lifts has been
identied as a frequent cause of back injury in the workplace.
1,10,11
Among various
work-related activities, lifting, awkward posture, heavy physical work and whole
body vibration have been indicated to have strong positive causal relationship with
the back MSDs.
1,12
To fully appreciate the link between external loads and forceful
exertions and LBP, accurate prediction of stresses and strains in spinal tissues have
been modeled.
1321
The relationship between LBP and the mechanics of the spineabdomen
system has been studied by various group.
21,22
It has been recognized that for a
healthy spine, stability and equilibrium conditions must be simultaneously insured
by proper neuromuscular function of trunk components.
2436
The role and
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-3
signicance of the intra-abdominal pressure (IAP), however, has remained con-
troversial despite few investigations on the eects of IAP on the mechanical charac-
teristics of the spine.
Historically, the limitations in modeling the complicated muscular structure of
the spineabdomen system have led investigators to assume auxiliary mechanisms
which assist the extensor muscles in supporting loads during lifting while satisfying
the equilibrium conditions.
2326,32,33,3638
A detailed description of these hypoth-
eses and their biomechanical evaluations including claims regarding the unloading
function of the IAP and load bearing mechanism of lumbodorsal fascia can be found
in a review article by McGill and Norman.
36
Many have argued the role of IAP in
unloading the spine and assisting the extensor muscles during lifting tasks.
26
More recently, the concept of higher IAP contributing to the stability of the
spine by stiening the spinal column has also been proposed.
25,39,40
Arjmand and
Shirazi-Adl
22
studied the role of IAP in the unloading and stabilization of the spine
during static lifting tasks using a novel kinematics-driven approach along with a
nonlinear nite element (FE) model of the thoracolumbar spine. They simulated the
IAP mechanical eects using an upward external force applied normal to the dia-
phragm and anterior to the T12 vertebra and concluded that in an upright standing
posture the unloading action of IAP faded away even in the presence of small
abdominal coactivities, while its stabilizing action improved as abdominal coac-
tivities increased. The mechanism of IAP generation via the abdominal muscles was
not explicitly considered in their study.
Other FE model studies on IAP mechanics have modeled the muscles as con-
tinuous ber-reinforced membranes that surround the intra-abdominal cavity and
produce IAP as they are activated.
21,41
These models allow for detailed investi-
gation on the eect of a particular muscle by changing the muscles architecture,
e.g., its ber-orientation.
41
Arjmand et al.
41
incorporated varying distribution,
cross-sectional area and ber orientation of muscles around the trunk and found
that muscles with horizontal ber direction have the greatest unloading eect.
Daggfeldt and Thorstensson
26
developed a mathematical model of the lumbar spine
considering a muscular layer around the abdominal cavity which was modeled as a
membrane. They reported similar results concerning the unloading advantage of the
transverse abdominis (TA). In almost all the previous modeling studies, however,
the interaction between muscle activation and IAP generation has not been simu-
lated. Instead the IAP eect has been introduced as an external force vector acting
on the diaphragm with a specied extension moment arm.
22,36
In the present study, an analytical model and an equivalent FE model of the
spineabdomen system have been developed to shed light on the mechanics of the
spine. Both models incorporate mechanisms of IAP self-generation in the abdominal
cavity due to abdominal muscle co-activation. The analytical model is more detailed
and accurate than the similar previous work
26
and provides a general parametric
H. Mokhtarzadeh
1250014-4
description of the mechanical interactions of the external load, IAP, spinal stiness
and spinal unloading potentials. The FE model, on the other hand, advances the
previous modeling studies,
41
by considering the role of the spinal column while
investigating the role of dierent trunk muscles and provides detailed quantitative
results of the mechanical eects of IAP.
2. Methods
2.1. Analytical model
A simple analytical model of the trunk was developed to investigate the general
eect of IAP on spine mechanics parametrically. The lumbar spine was modeled as a
straight deformable beam subjected to axial and shear loads. The diaphragm and
the pelvic ring were assumed to be rigid. The abdominal cavity was assumed to be
lled with a nearly incompressible uid. A single muscular layer, modeled as a thin
wall shell, was considered to surround the abdominal cavity with the transverse
ber orientation (0 0) (Fig. 1).
To derive the governing equations of the model, free body diagrams of the dia-
phragm and the spine were analyzed. The forces appearing in these diagrams include
the internal axial force, F
s
; moment, M
s
, of the lumbar spine acting at the L1 level;
IAP force, P.A; longitudinal tension in the muscle layer, o
z
; and, nally, external
force acting on the top of the diaphragm, F
e
(Fig. 2). P is the intra-abdominal
pressure (IAP) while R and A are the radius and cross-sectional area of the
diaphragm, respectively.
Fig. 1. The simplied model of the trunk in 3D (left) and sagittal plane (right).
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-5
Considering the equilibrium state of the diaphragm, one obtains:
F
s
F
e
PA2Rto
z
. 1
M
s
F
s
R. 2
Also, the equilibrium state of the thin wall muscular cylinder in horizontal plane
at a distance away from both ends yields:
o
0

PR
t
. 3
where o
0
is the hoop stress within the muscular cylinder.
Next, we consider the force-deformation and deformation compatibility
equations. With the rigid body assumption for the diaphragm, downward dis-
placement is due to axial shortening and angular deection of the spine beam
(Fig. 3). Therefore:
c
d

P
s
L
A
s
E
s

F
s
R
2
L
E
s
I
. 4
Fig. 2. The free body diagrams of the spine (left) and the diaphragm (right). o
z
.
Fig. 3. Upright spine and deformed spine with diaphragm.
H. Mokhtarzadeh
1250014-6
where L is the lumbar length, A
s
, E
s
and I are the geometrical and mechanical
properties of the spine beam; and c
d
is the downward displacement at the center of
the diaphragm.
For the abdominal muscular cylinder, the thin wall shell assumption yields:
c
r

R
E
0
o
0
0
0z
o
z
. 5
c
l

L
E
z
o
z
0
z0
o
0
. 6
where c
r
and c
l
are the radial and longitudinal deections of muscle layer, respec-
tively, and Youngs modulus (E
0
, E
z
) and Poissons ratios (0
0z
, 0
z0
) are given in
principal material directions, based on the muscle ber orientation.
Now, considering the simplication shown in Fig. 4, we can obtain the following
compatibility relationship: 2c
r
L c
d
L c
l
.
Then
2c
r
c
d
c
l
. 7
And, the variation ratio of the abdominal cavity volume,
V
V
0
, can be written as:
V
V
0

Rc
r

2
L c
d
R
2
R
2
L
. 8
So, if P and u
f
represent the IAP variation and the abdominal uid bulk
modulus, respectively, by ignoring the second-order terms of deformation we have:
P u
f
V
V
0
u
f
2c
r
L Rc
d
RL
. 9
Fig. 4. Intra-abdominal cavity before and after load exertion.
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-7
This provides a set of seven linear equations which describes the force-defor-
mation behavior of the trunk system thoroughly:
1 0 0 0 2Rt 0 A
0 R
2
2RL 0 0 0
R
2
L
u
f
0 0 E
0
0 Rv
0z
R 0
0 0 0 E
z
L Lv
0z
0
0 0 0 0 0 t R
0 1 2 1 0 0 0
l
E
s
1
A
s

R
2
I

1 2 1 0 0 0
2
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
4
3
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
5
F
s
c
d
c
r
c
l
o
z
o
0
P
2
6
6
6
6
6
6
6
6
6
6
6
6
6
4
3
7
7
7
7
7
7
7
7
7
7
7
7
7
5

F
e
0
0
0
0
0
0
2
6
6
6
6
6
6
6
6
6
6
6
6
6
6
4
3
7
7
7
7
7
7
7
7
7
7
7
7
7
7
5
. 10
In the above equation, the matrices include (from left) the geometrical and
material parameters of the spineabdomen system, the system variables and the
external loading on the system. In order to study the eect of the IAP on the
stiness and unloading of the spine, Eq. (10) can be solved to obtain IAP, spine
force, F
s
, and downward displacement of the centre of the diaphragm, c
d
, as
functions of the geometrical and material parameters of the system. In particular,
considering the fact that the muscle activation (increase of muscle tension, o
0
) can
be represented by increasing E
0
(Eq. (5)), we can calculate the rst derivatives of
the IAP, F
s
and c
d
with respect to E
0
, in order to study the eect of muscle
activation on these quantities (where E
z
is constant):
dP
dE
0

C
11
E
2
0
C
12
E
0
C
13
C
3
E
2
0
C
4
E
0
C
5

2
. 11
dF
s
dE
0

C
10
C
9
E
0
C
8

2
. 12
dc
d
dE
0

C
11
C
9
E
0
C
8

2
. 13
where C is are positive geometrical and/or material constants.
2.2. Finite element model
The eect of IAP on spine mechanics was also studied in detail using a FE model
of the trunk. The spine, rib cage and pelvic ring were modeled as beam elements with
the material properties obtained from the literature
24
(Table 1). The abdominal
cavity was assumed to be cylindrical and lled with a nearly incompressible uid
with high bulk modulus (u
f
1 MPa). The diaphragm was modeled as a plate at the
top of the abdominal cavity, and the vertical displacement of this plate simulated
H. Mokhtarzadeh
1250014-8
the active and/or passive functions of the diaphragm. The muscles surrounding the
cavity were modeled as a single layer of membrane with transversely isotropic
material properties in the muscles ber direction. This membrane was fully con-
strained at the lower end of the abdominal cavity and lumbar spine. The interaction
between the abdominal wall and uid was modeled by coupling constraints between
membrane nodes and adjacent uid nodes in the radial direction and between the
upper plate and uid in the vertical direction to simulate IAP generation.
The loading of the trunk system was simulated by moving the top plate down-
ward at a prescribed magnitude. This caused membrane force/stress in the muscle
layer, hydrostatic pressure in the abdomen and constraint (reactive) force on the
top plate. At rest, the muscle layer was assumed inactive (E
min
0.4 MPa),
41
and
the top plate was moved downward until the IAP reached 0.98 kPa in accordance
with an externally applied load of 96.5 N. Dierent levels of muscle activation were
simulated by increasing the Youngs modulus along all muscle bers until the
resulting IAP reached its maximum pressure (3.95 kPa) in accordance with
the partial Valsalva maneuver,
41
while maintaining the same downward displace-
ment. A normalized parameter u was dened to characterize the level of muscle
activation
41,42
:
u
E
E
v
u
min
< u < 1. 14
where E is the Youngs modulus of the muscle layer along the ber direction and E
v
is its maximum value associated with the partial Valsalva maneuver. The model was
analyzed using ANSYS 8 to study the eects of external load and muscle activation
on IAP, spinal stiness and spinal unloading. In order to study the eects of
dierent muscle types around the abdominal cavity, the architecture of the mus-
cular layer, i.e., the muscle thickness and ber orientation were changed.
Table 1. The geometrical and material property parameters of the FE model.
Description of variables and units Symbols Values used
Thickness of muscle layer (m) t 0.004545 (For TA)
Elasticity modulus of the spine (MPa) E
s
120
Radius of abdominal cavity (m) R 0.0678
Lenth of spine (m) L 0.2
Poissons ratio of muscle layer v
1
0.45
Poissons ratio of muscle layer v
2
0.45
Elasticity modulus of muscle layer in ber direction (Pa) E
m1
4e5
Elasticity modulus of muscle layer right to ber direction (Pa) E
m2
1.3e5
Bulk modulus of intra-abdominal cavity uids (Pa) u
f
1e6
Spines moments of inertia about x axis (m
4
) I
xx
5.85e-7
Spines moments of inertia about y axis (m
4
) I
yy
3.67e-7
Spines moments of inertia about z axis (m
4
) I
zz
3.67e-7
Poissons ratio of the spine v
xy
0.2
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-9
3. Results
3.1. Comparison between two models
At rst, the accuracy of the mathematical model was veried by comparison with
the 1-layer FE model. TA was the selected muscle layer for both models, since the
analytical model presented here assumed horizontal ber angle, 0 0. Also, TA
with a thickness of 4.54 mm,
41
unless mentioned, was used in the following results
of the analytical model. There exists a qualitative agreement between the two
models regardless of ber orientation although only results for 0 0 are presented
(Figs. 5(a)5(c)).
3.2. Analytical model
The general eects of the IAP on the mechanical behavior of the spineabdomen
system are described using Eqs. (10)(13) of the analytical model. Equation (10)
indicates that all the system variables, and in particular the IAP, spinal force, F
s
,
(a)
(b)
Fig. 5. Comparison of simple analytical model with the FE Model for TA (0 0

, t 4.54 mm), (a)

predicting IAP with increasing external force at u of 0.27; (b) predicting IAP with increasing muscle
activation, u, with external force at 96.5 N; (c) predicting unloading of spine with increasing external
force at activation level u of 0.27.
H. Mokhtarzadeh
1250014-10
and downward displacement of the diaphragm, F
d
, are linearly proportional to the
external load, F
e
, and increase when the load increases. Equation (11) describes the
eect of muscle activation, simulated by increasing E
0
, on IAP. Considering the fact
that with the system parameters within their anatomical and physiological range
the rst derivative of IAP against E
0
is always positive, our model predicts that IAP
increases nonlinearly with increasing muscle activation. On the other hand, Eq. (12)
indicates that for a given external load, F
e
, the rst derivative of spinal force,
F
s
, against E
0
is always negative. Therefore, increasing muscle activationcauses spine
unloading due to the increasing IAP. Finally, Eq. (13) describes the eect of muscle
activation, simulated by increasing E
0
, on the compliance of the spineabdomen
system, representedbythe downwarddisplacement of the center of the diaphragm, c
d
,
over the external force, F
e
. For a given external load, F
e
, the rst derivative of c
d
against E
0
is always negative, indicating that increase of muscle activation causes
a lower compliance (higher stiness) due to the increasing IAP. Detailed results
of the analytical model can be found in one of our previously published papers.
43
We consciously avoided tting the model parameters to match the FE results.
3.3. Finite element results
Figures 68 illustrate the detailed quantitative eects of the IAP on the spine
abdomen system, as predicted by the FE model. The IAP increased linearly with an
increasing external load for dierent muscle activation levels (Fig. 6). Also, at a
given external load, a higher IAP was obtained when the muscle activation level, u,
increased (Fig. 6). The IAP was 1.6 kPa at a low activation level of 0.27 and small
external load of 168 N but increased to about 3 kPa with the partial Valsalva
maneuver (u 1) for an external load of 196 N.
The muscle unloading was characterized in the results of the FE model by the
upward force acting on the diaphragm, F
e
F
s
. The eect of muscle activation on
spine unloading for dierent external loads is shown in Fig. 7. Spine unloading
increased nonlinearly with increasing muscle activations with a higher rate at low
(c)
Fig. 5. (Continued)
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-11
activation levels. For 100 N external load, the unloading increased with a sharp
nonlinear pattern from 15% to 23% and then linearly to about 43% of the external
load when the activation level increased from 0.27 to 0.33 and then to its maximum
(the partial Valsalva maneuver: u 1). At larger external forces, the magnitude of
spinal unloading increased, e.g., from 45 N to 70 N for 100 N and 160 N external
forces, respectively, at the maximum level of muscle activation (the partial Valsalva
maneuver: u 1). However, the percentage of unloading force over the external
load remained nearly constant.
The compliance of the spineabdomen system was characterized in the results of
the FE model by the downward displacement of the center of the diaphragm, c
d
,
over the external force, F
e
. The eect of muscle activation on the compliance of the
spineabdomen system is shown in Fig. 8. The system compliance decreased con-
siderably with higher muscle activations, indicating a higher stiness for the system
Fig. 6. The change of IAP with variation of the external load and muscle activation level, (0 0

,
t 4.545 mm).
Fig. 7. Eect of muscle activation on spinal unloading characterized by the upward force acting on the
diaphragm, F
e
F
s
, for dierent external loads (0 0

. t 4.545nm).
H. Mokhtarzadeh
1250014-12
due to the contribution of the IAP in bearing the external load. This eect was
identical for all external force levels examined and caused the compliance to change
from 0.097 mm/N at a 0.27 muscle activation level to about 0.043 mm/N for the
partial Valsalva maneuver (u 1).
The eect of the ber orientation and thickness of abdomen muscle on the
IAP, as predicted by the FE model, is illustrated in Figs. 9 and 10. By increasing
the ber orientation from circumferential (0 0) to longitudinal (0 90), the
eect of muscle activation on the IAP decreased considerably (Fig. 9). With muscle
activation at its maximum level, the IAP varied between 1.2 kPa and 3 kPa for
dierent external loads when the muscle bers were oriented circumferentially.
However, when the ber orientation changed to 60

oblique and higher towards

Fig. 8. Eect of muscle activation on the compliance of the spineabdomen system characterized by the
downward displacement of the centre of the diaphragm c
d
over the external force, F
e
, for dierent
external loads (0 0

, t 4.545 mm).
Fig. 9. The change of IAP with variation of the muscles bre direction for dierent external loads
(u 1, t 4.545 mm).
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-13
longitudinal, almost no IAP was produced. On the other hand, for a muscle with
circumferentially oriented bers at the maximum activation level, an increase in
the muscle thickness to two times the initial value resulted in a much higher IAP.
The rise in IAP was 75% and 100% for the light and heavy external loads,
respectively (Fig. 10).
4. Discussion
The spine has been the center of attention of many biomechanical evaluations on
how external loads are carried and partitioned between the trunk muscles and
osteoligamentous spine. Research on this complex phenomenon dates back to the
1920s when Keith
33
proposed the hypothesis that the unloading of the spine caused
by IAP can generate an extensor moment to assist back muscles during lifting.
However, the role of IAP has often been overestimated in earlier studies,
41
due to
the fact that researchers have either considered the IAP eect as an external force
vector acting on the diaphragm with a specied extension moment arm or neglected
the interactions between muscle activation and IAP generation. Such simplication
cannot directly evaluate the biomechanical advantages of recruitment strategies for
generating IAP. Furthermore, with the assumption of a large cross-sectional area
for the diaphragm and a large moment arm for the net upward force acting on it,
36
overestimated results are not surprising. It is believed that the eect of IAP on the
loading of the spine can be more accurately estimated when the mechanism of IAP
generation and the role of abdominal muscle activities are accounted for in the
model. In both the analytical and FE models of the present study, the mechanism of
IAP generation was considered and modeled. IAP was generated in the models by
activation of the muscle layer around the abdominal cavity. Moreover, the ana-
tomical nature of the models obviated the need to assign a priori known moment
arm to the net upward forces.
Fig. 10. The change of IAP with variation of the muscle layer thickness for dierent external loads
(0 0

, u 0.27 mm).
H. Mokhtarzadeh
1250014-14
The general features of the analytical and FE models of the present study are
similar to those of Daggfeldt and Thorstensson
26
and Arjmand et al.,
41
respectively.
However, some major and minor modications have been made to provide a more
realistic simulation of IAP and its eects on spine mechanics. These include
incorporating mechanisms of IAP self-generation due to muscle activations and a
more accurate anatomical representation for the attachment of the muscle layer to
the spine. Furthermore, we modeled the spinal column as a straight deformable
beam between the rib cage and pelvic oor, subjected to axial and shear loads. This
was a major advancement in comparison to the work of Arjmand et al.
41
who did not
introduce the role of the passive spine in their model. Also, in the mathematical
model of Daggfeldt et al.,
26
spine force and moment did not appear in the equations
governing equilibrium conditions.
The governing system of the equation of our analytical model (Eqs. (10)(12))
provided qualitative understanding of the inuence of input parameters such as
tension in the transverse direction of abdominal muscles on the unloading of the
spine, magnitude of IAP and spine compliance. Hence, we attempted no adjustment
to analytical model parameters to match (or t) the more detailed and exact
FE model results (Fig. 5). We have presented additional comparison results in
our prior work.
43
It is acknowledged that more simplications have been made in the analytical
model in order to simplify and linearize the governing equations, e.g. Eq. (9). Also,
the spine was attached to the muscle layer only in the upper and lower parts, so the
longitudinal tension at muscular layer, o
l
, was assumed to be constant along the
circumference of the diaphragm. These simplications, however, did not disturb
the general validity of the analytical model. The parametric description of the
mechanical interactions of the external load, IAP, spinal stiness and unloading
provided by the model was in good agreement with the quantitative results obtained
by the FE model. In particular the linear relationship between the external load and
the IAP, unloading force, F
e
F
s
, and spinal compliance, c
d
,F
e
, were similarly
predicted by both models.
The muscles in our FE model were considered as continuous ber-reinforced
membranes that surround the intra-abdominal cavity and have transverse isotropic
material properties with higher modulus of elasticity in their ber direction. This is
consistent with the fact that the muscles around the abdominal cavity act as
membrane elements and apply or resist force in their ber directions while oering
no bending stiness or through-depth resistance in their radial direction. In order to
simulate the muscle activation, a simple scheme was used in which dierent muscle
forces could be produced by changing the modulus of bers. This is, however, not
sucient for a realistic simulation of muscle activation since the independent con-
trol on muscle length is no longer available to the system. To remedy this, Shad-
mehr and Arbib
44
considered the feasibility of controlling not only the stiness but
also the resting length of the muscle. Also, a number of FE models have been
developed to allow control of both the length and force in the muscle.
42,45
Further
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-15
work is ongoing to extend this approach to the study of spine mechanics. Moreover,
in spite of the fact that the abdominal cavity is lled with some gas,
35
we assumed a
nearly incompressible uid within the cavity. This assumption was necessary con-
sidering the above limitations in modeling the muscle activations to increase the
IAP to very high pressures reported in the literature.
31
The results of both the analytical and FE models of the present study indicated
that for a given external load, the IAP increased considerably with higher muscle
activations. For an external load of 166 N, the IAP obtained was about 1.6 kPa at a
low activation level of 0.27 and about 2.5 kPa for the partial Valsalva maneuver
(Fig. 6). These increased for an external load of 196 N to 2 kPa and 3 kPa, respec-
tively. These results are consistent with the range of 0.98 to 3.9 kPa reported in the
literature for IAP under physiological conditions.
21,22,35,41,46
Our results concerning the unloading eects of IAP indicated that for a given
external load, the spinal unloading increased considerably when increasing muscle
activations at a rate similar to that of the IAP (Fig. 7). The unloading force varied
between 15% of the external load at low activation levels to as high as 40% at the
maximum level of muscle activation, and the rate of increase was higher at low
muscle activations, e.g., between 0.2 and 0.33. The percentage of unloading force
over the external load, F
e
F
s
,F
e
, however, remained constant with a changing
external load which is consistent with the linear relationship found for the external
load and spinal force in the analytical model (Eq. (10)). Such high unloading eects
have not been reported previously for IAP. Arjmand and Shirazi-Adl
22
reported
that the unloading role of IAP in the upright standing posture was negligible even in
the presence of a low level of abdominal coactivity while its stabilizing eect was
reported at moderate and high levels.
Our results suggest that activation of muscles with more circumferentially
oriented bers, e.g., TA and IOB, can contribute substantially in producing a high
IAP and unloading the spine. Also, a similar but less considerable eect exists for
muscles with oblique ber orientations up to 60

, e.g., EOB (Fig. 9). However,

activation of muscles with bers oriented more than 60

obliquely towards longi-

tudinal, e.g., ES, RA and LAT, does not contribute to IAP generation and conse-
quently spine unloading. These muscles might even impose an extra load to the
spine due to their downward force direction. The results of changing the muscle
thickness, on the other hand, suggests that for muscles with circumferentially
oriented bers, those with a greater thickness contribute more considerably in
IAP generation and spine unloading, particularly when heavier external loads
are applied (Fig. 10). These results are in good agreement with those of Arjmand
et al.
41
who reported the ability of abdomen muscles to generate IAP in descending
order of TA, IOB, EOB, RA, ES and LAT, based on their cross-sectional area
and orientation.
The role of the intra-abdominal cavity in stiening and stabilizing the lumbar
spine has been well documented in the biomechanical literature.
24,36
It has been
reported that the spine devoid of muscles collapses at an external load of only 100 N
H. Mokhtarzadeh
1250014-16
and the capability of the spinal system in bearing high physiological loads is mainly
due to the activation of the surrounding muscles.
26
Our results indicate that the
compliance of the spineabdomen system, characterized by the deection of the
spine (downward displacement of the diaphragm) over the external load, decreases
considerably with the activation of circumferentially oriented muscles and the
resulting higher IAP (Figs. 8 and 9). This might suggest that activation of such
muscles, e.g., TA, and the resulting IAP has a dual eect on spine mechanics, and
not only unloads the spine but stabilizes it without imposing compressive penalty
due to muscle forces.
47
Brown et al.
48
recently reported that spine stiness is greatly
aected by the anatomical characteristics of the surrounding musculature and
the selection of the muscular stiness. Their formulations, however, neglected
the nonlongitudinal function of muscle activation; hence, they cannot be used
to evaluate the eects of activation of circumferentially oriented muscles, e.g.,
TA, properly.
The FE model suers from the single muscle analysis where in reality geometrical
and anatomical detailed modeling requires representation of multiple layers of
muscles. In fact, within a given at muscle, such as internal and external oblique
muscles, the line of action (e.g., ber direction) that regionally varies should be
incorporated. The proper interface of muscles with a beam representing the spine
needs future detailed development. While achieving bio-delity for the model is a
signicant goal of any simulation study, the inclusion of a more realistic model with
the FE model, such as incorporating multiple muscles with anatomical cross-sec-
tional area, line of action and moment arms, demands a fundamental computational
innovation to solve muscle redundancies. The number of muscles is greater than the
number of equations governing static equilibrium. In addition, it is necessary to
develop methods that allow control of both the length and force of muscles at a
given activation. We are addressing these issues in current model studies. Future
models should enable us to understand the role of posture and velocity of trunk
during static and dynamic lifting tasks while considering both equilibrium and
stability of the spine.
An adequate simulation of spine stability and the role of IAP require a more
anatomically detailed model of the spine (i.e., considering the distributed weight of
upper body and uid content of abdominal cavity, the distributed exibility along
the spine and adjustable curvature of spine
14,15,19,22
and multiple curved muscles
around the abdominal cavity.
21
Although the Stokes et al. model
21
has many
improvements, it has only investigated the unloading of spine due to higher IAP
while neglecting the mechanisms that lead to the pressurization of abdominal
cavity. Their results of higher spinal unloading at higher IAP appear hence trivial
since the pressure is prescribed and not created by muscle activities. In this manner,
the compressive penalties of higher muscular forces in pressurizing the cavity
have been overlooked. The substantial increase in the L4-L5 disc pressure measured
in vivo during the Valsalva maneuver indicates the penalty of such pressuriz-
ing mechanisms in augmenting the compression force on the spine
49
Cholewicki
The Eects of Intra-abdominal Pressure on Stability and Unloading of the Spine
1250014-17
et al.
46
presented the experimental evidence for high correlation between muscular
coactivation of the abdominal and thoracic erector spinae muscles with IAP.
They argued that the stabilization of spine may be the more signicant goal of
higher IAP by co-activation than the unloading of spine. Others have also argued
for the possibility that at low levels of IAP without trunk muscle coactivation the
unloading may take place while at high levels of IAP (i.e., during maximum
voluntary exertions or full Valsalva maneuver with reported experimental values of
19 to 39 kPa) higher spinal loads are reported due to the concomitant higher levels of
muscle coactivation.
21,22,41,46
Hence, more anatomically detailed models should be
used to investigate the stiening of spine and its unloading as a phenomenon that
may be dependent on both the magnitude and mechanisms of the IAP generation.
Based on the preliminary results of this study, recruitment of horizontally oriented
muscles such as TA may increase the IAP without concurrent eect on the com-
pressive load on spine. The high levels of trunk muscle coactivation in upright
posture will add to the stiness of the spine but at the expense of higher spinal
loading1.
22,41
A more comprehensive and detailed model of the spineabdomen
system is now under development, in which a separate membrane has been intro-
duced for each individual trunk muscle, resulting in a more realistic appraisal of the
muscles synergistic activities as well as their unloading and stabilizing eects.
Notwithstanding the simplications of our model, based on our study, one can
support clinical and rehabilitation applications to train the strength, endurance and
coordination of the trunk muscles for more eective performance during functional
tasks in terms of the stability and equilibrium requirements. The role of TA muscles
in particular warrants more investigation as it is anatomically unique in stabilizing
the spine by increasing the IAP without creating the compressive penalty on the
spine given its line of action.
31,34,47,50
The higher IAP generated by this muscle
group has the potential to even unload the spine. These recommendations are in
agreement with the modeling and ergonomic observations that wearing corset or
belt facilitates abdominal pressurization and increases spinal stiness (stability) and
unloads the spine.
21,37,50,51
5. Conclusion
The simple analytical model indicated that activation of bers in the transverse
direction stiens the spine, unloads it and increases IAP. The FEmodel of single layer
trunk muscle representation with inclusion of the spine conrmed the analytical
models results; in addition, it showed the nonlinear response of ber direction and
IAP generation at a given external load, the linear eect of thickness on IAP, and the
nonlinear response of muscle activation and spinal unloading at any given external
load. The FE model is capable of modeling the eects of activation generated IAP on
both equilibrium and stability of spinal structure. More detailed anatomical delity
must advance this developing model by addressing computational techniques to
resolve redundancies in multiple muscle representation of spine biomechanics.
H. Mokhtarzadeh
1250014-18
Acknowledgment
This work was partly supported by grant no. 86.197 from Tehran University of
Medical Sciences, and partly by Hanyang University Research Foundation,
HY-2009-N.
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