Abstract
Knowledge of neck muscle activation strategies before sporting impacts is crucial for investigating mechanisms of severe spinal injuries. However, measurement of muscle activations during impacts is experimentally challenging and computational estimations are not often guided by experimental measurements. We investigated neck muscle activations before impacts with the use of electromyography (EMG)-assisted neuromusculoskeletal models. Kinematics and EMG recordings from four major neck muscles of a rugby player were experimentally measured during rugby activities. A subject-specific musculoskeletal model was created with muscle parameters informed from MRI measurements. The model was used in the calibrated EMG-informed neuromusculoskeletal modeling toolbox and three neural solutions were compared: (i) static optimization (SO), (ii) EMG-assisted (EMGa), and (iii) MRI-informed EMG-assisted (EMGaMRI). EMGaMRI and EMGa significantly (p < 0.01) outperformed SO when tracking cervical spine net joint moments from inverse dynamics in flexion/extension (RMSE = 0.95, 1.14, and 2.32 N·m) but not in lateral bending (RMSE = 1.07, 2.07, and 0.84 N·m). EMG-assisted solutions generated physiological muscle activation patterns and maintained experimental cocontractions significantly (p < 0.01) outperforming SO, which was characterized by saturation and nonphysiological “on-off” patterns. This study showed for the first time that physiological neck muscle activations and cervical spine net joint moments can be estimated without assumed a priori objective criteria before impacts. Future studies could use this technique to provide detailed initial loading conditions for theoretical simulations of neck injury during impacts.
Issue Section:
Research Papers
References
1.
Dennison
,
C. R.
,
Macri
,
E. M.
, and
Cripton
,
P. A.
, 2012
, “
Mechanisms of Cervical Spine Injury in Rugby Union: Is It Premature to Abandon Hyperflexion as the Main Mechanism Underpinning Injury?
,” Br. J. Sports Med.
,
46
(8
), pp. 545
–549
.10.1136/bjsports-2012-0912572.
Organization, W. H., and Society, I. S. C.
, 2013
, “
International Perspectives on Spinal Cord Injury
,” World Health Organization and International Spinal Cord Society, Malta, Report No. 9241564660.3.
Sekhon
,
L. H. S.
, and
Fehlings
,
M. G.
, 2001
, “
Epidemiology, Demographics, and Pathophysiology of Acute Spinal Cord Injury
,” Spine
,
26
(24S
), pp. S2–S12.4.
Yoganandan, N., Haffner, M., Maiman, D., Nichols, H., Pintar, F. A., Jentzen, J., Weinshel, S. S., Larson, S. J., and Sances, A., 1989, “Epidemiology and Injury Biomechanics of Motor Vehicle Related Trauma to the Human Spine,“
SAE
Technical Paper No. 89243.10.4271/8924385.
Priebe
,
M. M.
,
Chiodo
,
A. E.
,
Scelza
,
W. M.
,
Kirshblum
,
S. C.
,
Wuermser
,
L.-A.
, and
Ho
,
C. H.
, 2007
, “
Spinal Cord Injury Medicine. 6. Economic and Societal Issues in Spinal Cord Injury
,” Arch. Phys. Med. Rehabil.
,
88
(3
), pp. S84
–S88
.10.1016/j.apmr.2006.12.0056.
Bahr
,
R.
, and
Krosshaug
,
T.
, 2005
, “
Understanding Injury Mechanisms: A Key Component of Preventing Injuries in Sport
,” Br. J. Sports Med.
,
39
(6
), pp. 324
–329
.10.1136/bjsm.2005.0183417.
van Mechelen
,
W.
,
Hlobil
,
H.
, and
Kemper
,
H. C. G.
, 1992
, “
Incidence, Severity, Aetiology and Prevention of Sports Injuries
,” Sports Med.
,
14
(2
), pp. 82
–99
.10.2165/00007256-199214020-000028.
Holsgrove
,
T. P.
,
Cazzola
,
D.
,
Preatoni
,
E.
,
Trewartha
,
G.
,
Miles
,
A. W.
,
Gill
,
H. S.
, and
Gheduzzi
,
S.
, 2015
, “
An Investigation Into Axial Impacts of the Cervical Spine Using Digital Image Correlation
,” Spine J.
,
15
(8
), pp. 1856
–1863
.10.1016/j.spinee.2015.04.0059.
Nightingale
,
R. W.
,
McElhaney
,
J. H.
,
Richardson
,
W. J.
, and
Myers
,
B. S.
, 1996
, “
Dynamic Responses of the Head and Cervical Spine to Axial Impact Loading
,” J. Biomech.
,
29
(3
), pp. 307
–318
.10.1016/0021-9290(95)00056-910.
de Bruijn
,
E.
,
van der Helm
,
F. C. T.
, and
Happee
,
R.
, 2016
, “
Analysis of Isometric Cervical Strength With a Nonlinear Musculoskeletal Model With 48 Degrees of Freedom
,” Multibody Syst. Dyn.
,
36
(4
), pp. 339
–362
.10.1007/s11044-015-9461-z11.
Nightingale
,
R. W.
,
Sganga
,
J.
,
Cutcliffe
,
H.
, and
Bass
,
C. R.
, 2016
, “
Impact Responses of the Cervical Spine: A Computational Study of the Effects of Muscle Activity, Torso Constraint, and Pre-Flexion
,” J. Biomech.
,
49
(4
), pp. 558
–564
.10.1016/j.jbiomech.2016.01.00612.
Newell
,
R. S.
,
Siegmund
,
G. P.
,
Blouin
,
J.-S.
,
Street
,
J.
, and
Cripton
,
P. A.
, 2014
, “
Cervical Vertebral Realignment When Voluntarily Adopting a Protective Neck Posture
,” Spine
,
39
(15
), pp. E885–E893.13.
Saari
,
A.
,
Dennison
,
C. R.
,
Zhu
,
Q.
,
Nelson
,
T. S.
,
Morley
,
P.
,
Oxland
,
T. R.
,
Cripton
,
P. A.
, and
Itshayek
,
E.
, 2013
, “
Compressive Follower Load Influences Cervical Spine Kinematics and Kinetics During Simulated Head-First Impact in an In Vitro Model
,” ASME J. Biomech. Eng.
,
135
(11
), p. 111003
.10.1115/1.402482214.
Dibb
,
A. T.
,
Cox
,
C. A.
,
Nightingale
,
R. W.
,
Luck
,
J. F.
,
Cutcliffe
,
H. C.
,
Myers
,
B. S.
,
Arbogast
,
K. B.
,
Seacrist
,
T.
, and
Bass
,
C. R.
, 2013
, “
Importance of Muscle Activations for Biofidelic Pediatric Neck Response in Computational Models
,” Traffic Injury Prev.
,
14
(sup1
), pp. S116
–S127
.10.1080/15389588.2013.80679515.
Mortensen
,
J.
,
Trkov
,
M.
, and
Merryweather
,
A.
, 2018
, “
Exploring Novel Objective Functions for Simulating Muscle Coactivation in the Neck
,” J. Biomech.
,
71
, pp. 127
–134
.10.1016/j.jbiomech.2018.01.03016.
Kian
,
A.
,
Pizzolato
,
C.
,
Halaki
,
M.
,
Ginn
,
K.
,
Lloyd
,
D.
,
Reed
,
D.
, and
Ackland
,
D.
, 2019
, “
Static Optimization Underestimates Antagonist Muscle Activity at the Glenohumeral Joint: A Musculoskeletal Modeling Study
,” J. Biomech.
,
97
, p. 109348
.10.1016/j.jbiomech.2019.10934817.
Davico
,
G.
,
Pizzolato
,
C.
,
Lloyd
,
D. G.
,
Obst
,
S. J.
,
Walsh
,
H. P. J.
, and
Carty
,
C. P.
, 2020
, “
Increasing Level of Neuromusculoskeletal Model Personalisation to Investigate Joint Contact Forces in Cerebral Palsy: A Twin Case Study
,” Clinical Biomech.
,
72
, pp. 141
–149
.10.1016/j.clinbiomech.2019.12.01118.
Hoang
,
H. X.
,
Diamond
,
L. E.
,
Lloyd
,
D. G.
, and
Pizzolato
,
C.
, 2019
, “
A Calibrated EMG-Informed Neuromusculoskeletal Model Can Appropriately Account for Muscle co-Contraction in the Estimation of Hip Joint Contact Forces in People With Hip Osteoarthritis
,” J. Biomech.
,
83
, pp. 134
–142
.10.1016/j.jbiomech.2018.11.04219.
Serrancolí
,
G.
,
Kinney
,
A. L.
,
Fregly
,
B. J.
, and
Font-Llagunes
,
J. M.
, 2016
, “
Neuromusculoskeletal Model Calibration Significantly Affects Predicted Knee Contact Forces for Walking
,” ASME J. Biomech. Eng.
,
138
(8
), p. 081001.10.1115/1.403367320.
Blouin
,
J.-S.
,
Siegmund
,
G. P.
,
Carpenter
,
M. G.
, and
Inglis
,
J. T.
, 2007
, “
Neural Control of Superficial and Deep Neck Muscles in Humans
,” J. Neurophysiol.
,
98
(2
), pp. 920
–928
.10.1152/jn.00183.200721.
Siegmund
,
G. P.
,
Blouin
,
J.-S.
,
Brault
,
J. R.
,
Hedenstierna
,
S.
, and
Inglis
,
J. T.
, 2007
, “
Electromyography of Superficial and Deep Neck Muscles During Isometric, Voluntary, and Reflex Contractions
,” ASME J. Biomech. Eng.
,
129
(1
), pp. 66
–77
.10.1115/1.240118522.
Siegmund
,
G. P.
,
Blouin
,
J.-S.
,
Carpenter
,
M. G.
,
Brault
,
J. R.
, and
Inglis
,
J. T.
, 2008
, “
Are Cervical Multifidus Muscles Active During Whiplash and Startle? An Initial Experimental Study
,” BMC Musculoskeletal Disorders
,
9
(1
), pp. 80
–80
.10.1186/1471-2474-9-8023.
Cholewicki
,
J.
, and
McGill
,
S. M.
, 1994
, “
EMG Assisted Optimization: A Hybrid Approach for Estimating Muscle Forces in an Indeterminate Biomechanical Model
,” J. Biomech.
,
27
(10
), pp. 1287
–1289
.10.1016/0021-9290(94)90282-824.
Pizzolato
,
C.
,
Lloyd
,
D. G.
,
Sartori
,
M.
,
Ceseracciu
,
E.
,
Besier
,
T. F.
,
Fregly
,
B. J.
, and
Reggiani
,
M.
, 2015
, “
Ceinms: A Toolbox to Investigate the Influence of Different Neural Control Solutions on the Prediction of Muscle Excitation and Joint Moments During Dynamic Motor Tasks
,” J. Biomech.
,
48
(14
), pp. 3929
–3936
.10.1016/j.jbiomech.2015.09.02125.
Sartori
,
M.
,
Farina
,
D.
, and
Lloyd
,
D. G.
, 2014
, “
Hybrid Neuromusculoskeletal Modeling to Best Track Joint Moments Using a Balance Between Muscle Excitations Derived From Electromyograms and Optimization
,” J. Biomech.
,
47
(15
), pp. 3613
–3621
.10.1016/j.jbiomech.2014.10.00926.
Cheng
,
C.-H.
,
Chien
,
A.
,
Hsu
,
W.-L.
,
Chen
,
C. P.-C.
, and
Cheng
,
H.-Y. K.
, 2016
, “
Investigation of the Differential Contributions of Superficial and Deep Muscles on Cervical Spinal Loads With Changing Head Postures
,” PLoS One
,
11
(3
), p. e0150608
.10.1371/journal.pone.015060827.
Choi
,
H.
, 2003
, “
Quantitative Assessment of co-Contraction in Cervical Musculature
,” Med. Eng. Phys.
,
25
(2
), pp. 133
–140
.10.1016/S1350-4533(02)00151-028.
Cholewicki
,
J.
,
McGill
,
S. M.
, and
Norman
,
R. W.
, 1995
, “
Comparison of Muscle Forces and Joint Load From an Optimization and EMG Assisted Lumbar Spine Model: Towards Development of a Hybrid Approach
,” J. Biomech.
,
28
(3
), pp. 321
–331
.10.1016/0021-9290(94)00065-C29.
Molinaro
,
D. D.
,
King
,
A. S.
, and
Young
,
A. J.
, 2020
, “
Biomechanical Analysis of Common Solid Waste Collection Throwing Techniques Using Opensim and an EMG-Assisted Solver
,” J. Biomech.
,
104
, p. 109704
.10.1016/j.jbiomech.2020.10970430.
Wesseling
,
M.
,
De Groote
,
F.
,
Bosmans
,
L.
,
Bartels
,
W.
,
Meyer
,
C.
,
Desloovere
,
K.
, and
Jonkers
,
I.
, 2016
, “
Subject-Specific Geometrical Detail Rather Than Cost Function Formulation Affects Hip Loading Calculation
,” Comput. Methods Biomech. Biomed. Eng.
,
19
(14
), pp. 1475
–1488
.10.1080/10255842.2016.115454731.
O'Brien
,
T. D.
,
Reeves
,
N. D.
,
Baltzopoulos
,
V.
,
Jones
,
D. A.
, and
Maganaris
,
C. N.
, 2010
, “
In Vivo Measurements of Muscle Specific Tension in Adults and Children
,” Exp. Physiol.
,
95
(1
), pp. 202
–210
.10.1113/expphysiol.2009.04896732.
Suderman
,
B. L.
, and
Vasavada
,
A. N.
, 2017
, “
Neck Muscle Moment Arms Obtained in-Vivo From Mri: Effect of Curved and Straight Modeled Paths
,” Ann. Biomed. Eng.
,
45
(8
), pp. 2009
–2024
.10.1007/s10439-017-1830-833.
Au
,
J.
,
Perriman
,
D. M.
,
Pickering
,
M. R.
,
Buirski
,
G.
,
Smith
,
P. N.
, and
Webb
,
A. L.
, 2016
, “
Magnetic Resonance Imaging Atlas of the Cervical Spine Musculature
,” Clin. Anat.
,
29
(5
), pp. 643
–659
.10.1002/ca.2273134.
Moeller
,
T. B.
, and
Reif
,
E.
, 2007
, Pocket Atlas of Sectional Anatomy. Computer Tomography and Magnetic Resonance Imaging
, Vol.
3
,
Spine, Extremities, Joints
,
Thieme, Germany
.35.
Cazzola
,
D.
,
Holsgrove
,
T. P.
,
Preatoni
,
E.
,
Gill
,
H. S.
, and
Trewartha
,
G.
, 2017
, “
Cervical Spine Injuries: A Whole-Body Musculoskeletal Model for the Analysis of Spinal Loading
,” PLoS One
,
12
(1
), p. e0169329
.10.1371/journal.pone.016932936.
Cazzola
,
D.
,
Preatoni
,
E.
,
Stokes
,
K. A.
,
England
,
M. E.
, and
Trewartha
,
G.
, 2015
, “
A Modified Prebind Engagement Process Reduces Biomechanical Loading on Front Row Players During Scrummaging: A Cross-Sectional Study of 11 Elite Teams
,” Br. J. Sports Med.
,
49
(8
), pp. 541
–546
.10.1136/bjsports-2013-09290437.
Preatoni
,
E.
,
Cazzola
,
D.
,
Stokes
,
K. A.
,
England
,
M.
, and
Trewartha
,
G.
, 2016
, “
Pre-Binding Prior to Full Engagement Improves Loading Conditions for Front-Row Players in Contested Rugby Union Scrums
,” Scand. J. Med. Sci. Sports
,
26
(12
), pp. 1398
–1407
.10.1111/sms.1259238.
Seminati
,
E.
,
Cazzola
,
D.
,
Preatoni
,
E.
, and
Trewartha
,
G.
, 2017
, “
Specific Tackling Situations Affect the Biomechanical Demands Experienced by Rugby Union Players
,” Sports Biomech.
,
16
(1
), pp. 58
–75
.10.1080/14763141.2016.119445339.
Cazzola
,
D.
,
Stone
,
B.
,
Holsgrove
,
T. P.
,
Trewartha
,
G.
, and
Preatoni
,
E.
, 2016
, “
Spinal Muscle Activity in Simulated Rugby Union Scrummaging is Affected by Different Engagement Conditions
,” Scand. J. Med. Sci. Sports
,
26
(4
), pp. 432
–838
.10.1111/sms.1244640.
Brauge
,
D.
,
Delpierre
,
C.
,
Adam
,
P.
,
Sol
,
J. C.
,
Bernard
,
P.
, and
Roux
,
F.-E.
, 2015
, “
Clinical and Radiological Cervical Spine Evaluation in Retired Professional Rugby Players
,” J. Neurosurg.
,
23
(5
), pp. 551
–557
.10.3171/2015.1.SPINE1459441.
Lloyd
,
D. G.
, and
Besier
,
T. F.
, 2003
, “
An Emg-Driven Musculoskeletal Model to Estimate Muscle Forces and Knee Joint Moments In Vivo
,” J. Biomech.
,
36
(6
), pp. 765
–776
.10.1016/S0021-9290(03)00010-142.
Mortensen
,
J. D.
,
Vasavada
,
A. N.
, and
Merryweather
,
A. S.
, 2018
, “
The Inclusion of Hyoid Muscles Improve Moment Generating Capacity and Dynamic Simulations in Musculoskeletal Models of the Head and Neck
,” PLoS One
,
13
(6
), p. e0199912
.10.1371/journal.pone.019991243.
Delp
,
S. L.
,
Anderson
,
F. C.
,
Arnold
,
A. S.
,
Loan
,
P.
,
Habib
,
A.
,
John
,
C. T.
,
Guendelman
,
E.
, and
Thelen
,
D. G.
, 2007
, “
Opensim: Open-Source Software to Create and Analyze Dynamic Simulations of Movement
,” IEEE Trans. Biomed. Eng.
,
54
(11
), pp. 1940
–1950
.10.1109/TBME.2007.90102444.
Vasavada
,
A. N.
,
Li
,
S. P.
, and
Delp
,
S. L.
, 1998
, “
Influence of Muscle Morphometry and Moment Arms on the Moment-Generating Capacity of Human Neck Muscles
,” Spine
,
23
(4
), pp. 412
–422
.10.1097/00007632-199802150-0000245.
Kuo
,
C.
,
Sheffels
,
J.
,
Fanton
,
M.
,
Yu Ina
,
B.
,
Hamalainen
,
R.
, and
Camarillo
,
D.
, 2019
, “
Passive Cervical Spine Ligaments Provide Stability During Head Impacts
,” J. R. Soc. Interface
,
16
(154
), p. 20190086
.10.1098/rsif.2019.008646.
Vasavada
,
A. N.
,
Lasher
,
R. A.
,
Meyer
,
T. E.
, and
Lin
,
D. C.
, 2008
, “
Defining and Evaluating Wrapping Surfaces for MRI-Derived Spinal Muscle Paths
,” J. Biomech.
,
41
(7
), pp. 1450
–1457
.10.1016/j.jbiomech.2008.02.02747.
Beaucage-Gauvreau
,
E.
,
Robertson
,
W. S. P.
,
Brandon
,
S. C. E.
,
Fraser
,
R.
,
Freeman
,
B. J. C.
,
Graham
,
R. B.
,
Thewlis
,
D.
, and
Jones
,
C. F.
, 2019
, “
Validation of an Opensim Full-Body Model With Detailed Lumbar Spine for Estimating Lower Lumbar Spine Loads During Symmetric and Asymmetric Lifting Tasks
,” Comput. Methods Biomech. Biomed. Eng.
,
22
(5
), pp. 451
–464
.10.1080/10255842.2018.156481948.
Sherman
,
M. A.
,
Seth
,
A.
, and
Delp
,
S. L.
, 2013
, “
What is a Moment Arm? Calculating Muscle Effectiveness in Biomechanical Models Using Generalised Coordinates
,” ASME
Paper No. DETC2013-13633.10.1115/DETC2013-1363349.
Heiden
,
T. L.
,
Lloyd
,
D. G.
, and
Ackland
,
T. R.
, 2009
, “
Knee Joint Kinematics, Kinetics and Muscle co-Contraction in Knee Osteoarthritis Patient Gait
,” Clin. Biomech.
,
24
(10
), pp. 833
–841
.10.1016/j.clinbiomech.2009.08.00550.
Arjmand
,
N.
,
Gagnon
,
D.
,
Plamondon
,
A.
,
Shirazi-Adl
,
A.
, and
Larivière
,
C.
, 2010
, “
A Comparative Study of Two Trunk Biomechanical Models Under Symmetric and Asymmetric Loadings
,” J. Biomech.
,
43
(3
), pp. 485
–491
.10.1016/j.jbiomech.2009.09.03251.
Gagnon
,
D.
,
Arjmand
,
N.
,
Plamondon
,
A.
,
Shirazi-Adl
,
A.
, and
Larivière
,
C.
, 2011
, “
An Improved Multi-Joint Emg-Assisted Optimization Approach to Estimate Joint and Muscle Forces in a Musculoskeletal Model of the Lumbar Spine
,” J. Biomech.
,
44
(8
), pp. 1521
–1529
.10.1016/j.jbiomech.2011.03.00252.
Nightingale
,
R. W.
,
Bass
,
C. R.
, and
Myers
,
B. S.
, 2019
, “
On the Relative Importance of Bending and Compression in Cervical Spine Bilateral Facet Dislocation
,” Clin. Biomech.
,
64
, pp. 90
–97
.10.1016/j.clinbiomech.2018.02.01553.
Newell
,
R. S.
,
Blouin
,
J.-S.
,
Street
,
J.
,
Cripton
,
P. A.
, and
Siegmund
,
G. P.
, 2018
, “
The Neutral Posture of the Cervical Spine is Not Unique in Human Subjects
,” J. Biomech.
,
80
, pp. 53
–62
.10.1016/j.jbiomech.2018.08.01254.
Walter
,
J. P.
,
Kinney
,
A. L.
,
Banks
,
S. A.
,
D'Lima
,
D. D.
,
Besier
,
T. F.
,
Lloyd
,
D. G.
, and
Fregly
,
B. J.
, 2014
, “
Muscle Synergies May Improve Optimization Prediction of Knee Contact Forces During Walking
,” ASME J. Biomech. Eng.
,
136
(2
), p. 021031.10.1115/1.402642855.
Moroney
,
S. P.
,
Schultz
,
A. B.
, and
Miller
,
J. A. A.
, 1988
, “
Analysis and Measurement of Neck Loads
,” J. Orthop. Res.
,
6
(5
), pp. 713
–720
.10.1002/jor.110006051456.
McGill
,
S.
,
Juker
,
D.
, and
Kropf
,
P.
, 1996
, “
Appropriately Placed Surface EMG Electrodes Reflect Deep Muscle Activity (Psoas, Quadratus Lumborum, Abdominal Wall) in the Lumbar Spine
,” J. Biomech.
,
29
(11
), pp. 1503
–1507
.10.1016/0021-9290(96)84547-757.
Van den Abbeele
,
M.
,
Li
,
F.
,
Pomero
,
V.
,
Bonneau
,
D.
,
Sandoz
,
B.
,
Laporte
,
S.
, and
Skalli
,
W.
, 2018
, “
A Subject-Specific Biomechanical Control Model for the Prediction of Cervical Spine Muscle Forces
,” Clin. Biomech.
,
51
, pp. 58
–66
.10.1016/j.clinbiomech.2017.12.00158.
Assila
,
N.
,
Pizzolato
,
C.
,
Martinez
,
R.
,
Lloyd
,
D. G.
, and
Begon
,
M.
, 2020
, “
Emg-Assisted Algorithm to Account for Shoulder Muscles Co-Contraction in Overhead Manual Handling
,” Appl. Sci.
,
10
(10
), p. 3522
.10.3390/app1010352259.
Hoang
,
H. X.
,
Pizzolato
,
C.
,
Diamond
,
L. E.
, and
Lloyd
,
D. G.
, 2018
, “
Subject-Specific Calibration of Neuromuscular Parameters Enables Neuromusculoskeletal Models to Estimate Physiologically Plausible Hip Joint Contact Forces in Healthy Adults
,” J. Biomech.
,
80
, pp. 111
–120
.10.1016/j.jbiomech.2018.08.02360.
Veerkamp
,
K.
,
Waterval
,
N.
,
Geijtenbeek
,
T.
,
Carty
,
C.
,
Lloyd
,
D.
,
Harlaar
,
J.
, and
van der Krogt
,
M.
, 2021
, “
Evaluating Cost Function Criteria in Predicting Healthy Gait
,” J. Biomech.
,
123
, p. 110530
.10.1016/j.jbiomech.2021.11053061.
Diamond
,
L.
,
Hoang
,
H.
,
Barrett
,
R.
,
Loureiro
,
A.
,
Constantinou
,
M.
,
Lloyd
,
D.
, and
Pizzolato
,
C.
, 2020
, “
Individuals With Mild-to-Moderate Hip Osteoarthritis Walk With Lower Hip Joint Contact Forces Despite Higher Levels of Muscle co-Contraction Compared to Healthy Individuals
,” Osteoarthritis Cartilage
,
28
(7
), pp. 924
–931
.10.1016/j.joca.2020.04.008Copyright © 2022 by ASME
You do not currently have access to this content.
