Many problems of the lumbar spine that cause pain are attributed to instability. The ligamentous spine (without muscles) is unstable at very low compressive loads. This study examined the hypothesis that instability of the lumbar spine is prevented under normal circumstances by the stiffness of spinal musculature, without active responses from the neuromuscular control system. The effect of muscle activity (force and stiffness) on the stability of the lumbar spine was analyzed for maximum voluntary extension efforts with different spinal postures in the sagittal plane. The analysis included realistic three-dimensional representation of the muscular anatomy with muscles crossing several motion segments. The stiffness of motion segments was represented using in vitro measured properties. Under a range of conditions with maximum extension effort, active muscle stiffness was required to prevent the lumbar spine from buckling. The dimensionless value of the muscle stiffness parameter q as a function of activation and length had to be greater than a critical value in the range of 3.7-4.7 in order to stabilize the spine. Experimentally determined values of q ranged from 0.5 to 42. These analyses demonstrate how changes in motion segment stiffness, muscle activation strategy, or muscle stiffness (due to degenerative changes, injuries, fatigue, and so on) might lead to spinal instability and "self-injury."

Human intervertebral disc specimens were tested to determine the regions of largest maximum shear strain experienced by disc tissues in each of three principal displacements and three rotations, and to identify the physiological rotations and displacements that may place the disc at greatest risk for large tissue strains and injury. Tearing of disc annulus may be initiated by large interlamellar shear strains. Nine human lumbar discs were tagged with radiographic markers on the endplates, disc periphery and with a grid of wires in the mid-transverse plane and subjected to each of the six principal displacements and rotations. Stereo-radiographs were taken in each position and digitized for reconstruction of the 3-D position of each marker. Maximum tissue shear strains were calculated from relative marker displacements and normalized by the input displacement or rotation. Lateral shear, compression, and lateral bending were the motions that produced the mean (95% confidence interval) largest regional maximum shear strains (MSS) of 9.6 (0.7) %/mm, 9.0 (0.5) %/mm, and 5.8 (1.6) %/° respectively, and which occurred in the posterior, posterolateral and lateral peripheral regions of the disc. After taking into account the reported maximum physiological range of motion for each degree of freedom, motions producing the highest physiological MSS were lateral bending (57.8 (16.2)%) and flexion (38.3 (3.3)%), followed by lateral shear (14.4 (1.1)%) and compression (12.6 (0.7)%).

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