Evaluation of Lifting Techniques Using Optoelectronic Systems with Knee Range of Motion Restrictions

Abstract

This study explored the effect of knee range of motion (ROM) restrictions on lumbar spine kinematics and posterior chain muscle activity during squat and stoop lifting tasks. This relationship reflects the concept of regional interdependence, where impairments in one anatomical area may influence others, a key principle in the kinetic chain approach. Fifteen healthy adults performed squat and stoop lifting tasks under three knee ROM conditions (squat: free/0–60°/0–90°; stoop: free/0°/0–30°) using optoelectronic motion capture and electromyographic (EMG) systems. One-way analysis of variance was applied to analyze lumbar spine angles in flexion/extension, side bending, and rotation and to assess muscle activation patterns for five posterior chain muscles. No significant effects of knee ROM restrictions were observed for lumbar flexion/extension or side bending (p>0.15), but pelvic rotation differed significantly (p=0.0103). EMG analysis showed increased activation of the Gastrocnemius Lateralis and Biceps Femoris (p<0.001), while Gluteus Maximus and Latissimus Dorsi activation remained unchanged. Knee ROM restrictions influenced EMG muscle activation in distal posterior chain muscles and altered pelvic rotation, suggesting localized compensatory mechanisms. Results highlight the variation in muscle activation patterns and kinetic adjustments during squat and stoop lifting tasks in healthy individuals simulating knee ROM deficits, osteoarthritis, or low back pain conditions.

Keywords

lumbar vertebrae - biomechanical phenomena - knee joint - lifting - exercise movement techniques

Publication History

Received: 17 February 2025

Accepted after revision: 14 May 2025

Accepted Manuscript online:
14 May 2025

Article published online:
29 July 2025

• References

• 1 Firouzabadi A, Arjmand N, Zhang T, Pumberger M, Schmidt H. Effect of low back pain on the kinetics and kinematics of the lumbar spine – a combined in vivo and in silico investigation. J Biomech 2024; 164: 111954
• 2 Gombatto SP, D’Arpa N, Landerholm S. et al. Differences in kinematics of the lumbar spine and lower extremities between people with and without low back pain during the down phase of a pick-up task, an observational study. Musculoskelet Sci Pract 2017; 28: 25-31
• 3 Saraceni N, Kent P, Ng L, Campbell A, Straker L, O’Sullivan P. To flex or not to flex? is there a relationship between lumbar spine flexion during lifting and low back pain? a systematic review with meta-analysis. J Orthop Sports Phys Ther 2020; 50 (03) 121-130
• 4 Saraceni N, Campbell A, Kent P, Ng L, Straker L, O’Sullivan P. Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP. PLoS One 2021; 16 (07) e0254241
• 5 Panjabi MM, Takata K, Goel VK. Kinematics of lumbar intervertebral foramen. Spine 1983; 8 (04) 348-357
• 6 Gombatto SP, Brock T, DeLork A, Jones G, Madden E, Rinere C. Lumbar spine kinematics during walking in people with and people without low back pain. Gait Posture 2015; 42 (04) 539-544
• 7 Hashemirad F, Talebian S, Hatef B, Kahlaee AH. The relationship between flexibility and EMG activity pattern of the erector spinae muscles during trunk flexion-extension. J Electromyogr Kinesiol 2009; 19 (05) 746-753
• 8 Belavý DL, Quittner MJ, Ridgers N, Ling Y, Connell D, Rantalainen T. Running exercise strengthens the intervertebral disc. Sci Rep 2017; 7: 45975
• 9 Zhong W, Driscoll SJ, Tsai TY. et al. In vivo dynamic changes of dimensions in the lumbar intervertebral foramen. Spine J 2015; 15 (07) 1653-1659
• 10 Tavana S, Davis B, Canali I. et al. A novel tool to quantify in vivo lumbar spine kinematics and 3D intervertebral disc strains using clinical MRI. J Mech Behav Biomed Mater 2023; 140: 105730
• 11 Tay YX, Foley S, Killeen R. et al. Impact and effect of imaging referral guidelines on patients and radiology services: a systematic review. Eur Rad 2025; 35 (01) 532-541
• 12 Stahl CM, Meisinger QC, Andre MP, Kinney TB, Newton IG. Radiation risk to the fluoroscopy operator and staff. AJR Am J Roentgenol 2016; 207 (04) 737-744
• 13 Mousavi SJ, Tromp R, Swann MC, White AP, Anderson DE. Between-session reliability of opto-electronic motion capture in measuring sagittal posture and 3-D ranges of motion of the thoracolumbar spine. J Biomech 2018; 79: 248-252
• 14 Robert-Lachaine X, Mecheri H, Muller A, Larue C, Plamondon A. Validation of a low-cost inertial motion capture system for whole-body motion analysis. J Biomech 2020; 99: 109520
• 15 Leardini A, Chiari L, Della Croce U, Cappozzo A. Human movement analysis using stereophotogrammetry. Part 3. Soft tissue artifact assessment and compensation. Gait Posture 2005; 21 (02) 212-225
• 16 Cappozzo A, Catani F, Leardini A, Benedetti MG, Croce UD. Position and orientation in space of bones during movement: experimental artefacts. Clin Biomech 1996; 11 (02) 90-100
• 17 Lucchetti L, Cappozzo A, Cappello A, Della Croce U. Skin movement artefact assessment and compensation in the estimation of knee-joint kinematics. J Biomech 1998; 31 (11) 977-984
• 18 Ancillao A, Aertbeliën E, De Schutter J. Effect of the soft tissue artifact on marker measurements and on the calculation of the helical axis of the knee during a gait cycle: A study on the CAMS-Knee data set. Hum Mov Sci 2021; 80: 102866
• 19 D’Isidoro F, Brockmann C, Ferguson SJ. Effects of the soft tissue artefact on the hip joint kinematics during unrestricted activities of daily living. J Biomech 2020; 104: 109717
• 20 Xi X, Ling Z, Wang C. et al. Lumbar segment-dependent soft tissue artifacts of skin markers during in vivo weight-bearing forward-Backward bending. Front Bioeng Biotechnol 2022; 10: 960063
• 21 Almansoof HS, Nuhmani S, Muaidi Q. Role of kinetic chain in sports performance and injury risk: a narrative review. J Med Life 2023; 16 (11) 1591-1596
• 22 Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther 2007; 37 (11) 658-660
• 23 Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of workplace manual handling or assisting patients and low back pain: results of a systematic review. Spine J 2010; 10 (07) 639-651
• 24 Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. Spine J 2010; 10 (01) 89-99
• 25 Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational sitting and low back pain: results of a systematic review. Spine J 2010; 10 (03) 252-261
• 26 Iqbal R, De A, Mishra W, Maulik S, Chandra AM. Study on lumbar kinematics and the risk of low back disorder in female university students by using shoes of different heel heights. Work 2012; 41 Suppl 1: 2521-2526
• 27 Mika A, Clark BC, Oleksy Ł. The influence of high and low heeled shoes on EMG timing characteristics of the lumbar and hip extensor complex during trunk forward flexion and return task. Man Ther 2013; 18 (06) 506-511
• 28 Rahimi A, Arab AM, Nourbakhsh MR. et al. Lower limb kinematics in individuals with chronic low back pain during walking. J Electromyogr Kinesiol 2020; 51: 102404
• 29 Danneels LA, Vanderstraeten GG, Cambier DC. et al. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Brit J Sports Med 2001; 35 (03) 186-191
• 30 Sions JM, Elliott JM, Pohlig RT, Hicks GE. Trunk muscle characteristics of the multifidi, erector spinae, psoas, and quadratus lumborum in older adults with and without chronic low back pain. J Orthop Sports Phys Ther 2017; 47 (03) 173-179
• 31 Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain: different time points, observations, and mechanisms. J Orthop Sports Phys Ther 2019; 49 (06) 464-476
• 32 Seyedhoseinpoor T, Taghipour M, Dadgoo M. et al. Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J 2022; 22 (04) 660-676
• 33 Ramsey DK, Lamontagne M, Wretenberg PF. Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee. Clin Biomech 2001; 16 (01) 61-70
• 34 Focke A, Steingrebe H, Möhler F. et al. Effect of different knee braces in ACL-deficient patients. Front Bioeng Biotechnol 2020; 8: 964
• 35 Rahman NA, Li S, Schmid S, Shaharudin S. Biomechanical factors associated with non-specific low back pain in adults: A systematic review. Phys Ther Sport 2023; 59: 60-72
• 36 Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J 2010; 10 (06) 554-566
• 37 Viechtbauer W, Smits L, Kotz D. et al. A simple formula for the calculation of sample size in pilot studies. J Clin Epidemiol 2015; 68: 1375-1379
• 38 Hermens HJ, Freriks B, Merletti R. et al. European recommendations for surface electromyography: Results of the SENIAM Project 1999
• 39 Washmuth NB, McAfee AD, Bickel CS. Lifting techniques: why are we not using evidence to optimize movement?. Int J Sports Phys Ther 2022; 17 (01) 104-110
• 40 van Dieën JH, Hoozemans MJ, Toussaint HM. Stoop or squat: a review of biomechanical studies on lifting technique. Clin Biomech 1999; 14 (10) 685-696
• 41 von Arx M, Liechti M, Connolly L, Bangerter C, Meier ML, Schmid S. From stoop to squat: a comprehensive analysis of lumbar loading among different lifting styles. Front Bioeng Biotechnol 2021; 9: 769117
• 42 Reynolds J. Field’s anatomy, palpation & surface markings. Phys Ther Sport 2013; 14 (03) 183
• 43 Comfort P, Dos’Santos T, Beckham GK. et al. Standardization and methodological considerations for the isometric midthigh pull. Strength Cond J 2019; 41 (02) 57-79
• 44 Lees A, Barton G, Robinson M. The influence of Cardan rotation sequence on angular orientation data for the lower limb in the soccer kick. J Sports Sci 2010; 28 (04) 445-450
• 45 Serrien B, Clijsen R, Blondeel J. et al. Differences in ball speed and three-dimensional kinematics between male and female handball players during a standing throw with run-up. BMC Sports Sci Med Rehabil 2015; 7: 27
• 46 Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet 2012; 379 (9814) 482-491
• 47 Caneiro JP, O’Sullivan P, Smith A. et al. Physiotherapists Implicitly evaluate bending and lifting with a round back as dangerous. Musculoskelet Sci Pract 2019; 39: 107-114
• 48 Nolan D, O’Sullivan K, Stephenson J, O’Sullivan P, Lucock M. What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice?. Musculoskelet Sci Pract 2018; 33: 35-40
• 49 Hartmann H, Wirth K, Klusemann M. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med 2013; 43 (10) 993-1008
• 50 Rojas-Jaramillo A, Cuervo-Arango DA, Quintero JD. et al. Impact of the deep squat on articular knee joint structures, friend or enemy? A scoping review. Front Sports Act Living 2024; 6: 1477796
• 51 Laird RA, Gilbert J, Kent P, Keating JL. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2014; 15: 229
• 52 Laird RA, Keating JL, Kent P. Subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain. BMC Musculoskelet Disord 2018; 19 (01) 309
• 53 Kastelic K, Voglar M, Šarabon N. Acute effect of full time office work in real environment on postural actions and lumbar range of motion. J Electromyogr Kinesiol 2018; 43: 82-87
• 54 Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord 2021; 22 (01) 998
• 55 Nascimento MB, Vilarinho LG, Lobato DFM, Dionisio VC. Role of gluteus maximus and medius activation in the lower limb biomechanical control during functional single-leg tasks: a systematic review. Knee 2023; 43: 163-175
• 56 Hirose N, Tsuruike M. Differences in the electromyographic activity of the hamstring, gluteus maximus, and erector spinae muscles in a variety of kinetic changes. J Strength Cond Res 2018; 32 (12) 3357-3363
• 57 McMullin P, Emmett D, Gibbons A. et al. Dynamic segmental kinematics of the lumbar spine during diagnostic movements. Front Bioeng Biotechnol 2023; 11: 1209472