Biomech Model Mechanobiol

DOI 10.1007/s10237-015-0656-2

ORIGINAL PAPER

A forward dynamics simulation of human lumbar spine flexion

predicting the load sharing of intervertebral discs, ligaments,
and muscles
T. K. Rupp W. Ehlers N. Karajan M. Gnther
S. Schmitt

Received: 29 July 2014 / Accepted: 22 January 2015

Springer-Verlag Berlin Heidelberg 2015

Abstract Determining the internal dynamics of the human nonlinearly. As results, internal kinematics, muscle forces,
spines biological structure is one essential step that allows and internal loads for each biological structure are presented.
enhanced understanding of spinal degeneration processes. A comparison between the nonlinear (new, enhanced mod-
The unavailability of internal load figures in other methods elling approach) and linear (standard modelling approach,
highlights the importance of the forward dynamics approach bushing) modelling approaches of the intervertebral disc is
as the most powerful approach to examine the internal degen- presented. The model is available to all researchers as ready-
eration of spinal structures. Consequently, a forward dynam- to-use C/C++ code within our in-house multi-body simula-
ics full-body model of the human body with a detailed lumbar tion code demoa with all relevant binaries included.
spine is introduced. The aim was to determine the internal
dynamics and the contribution of different spinal structures to Keywords Biomechanics Direct dynamics Multi-body
loading. The multi-body model consists of the lower extrem- model Impact Shock wave Computer simulation
ities, two feet, shanks and thighs, the pelvis, five lumbar ver-
tebrae, and a lumped upper body including the head and both
arms. All segments are modelled as rigid bodies. 202 muscles Abbreviations
(legs, back, abdomen) are included as Hill-type elements. 58
nonlinear force elements are included to represent all spinal IVD Intervertebral disc
ligaments. The lumbar intervertebral discs were modelled MTC Muscletendon complex
MB Multi-body
T. K. Rupp M. Gnther S. Schmitt (B) FE Finite element
Institute of Sports and Movement Science, University of Stuttgart, DOF Degree of freedom
Allmandring 28, 70569 Stuttgart, Germany
CT Computed tomography
e-mail: schmitt@inspo.uni-stuttgart.de
URL: http://www.inspo.uni-stuttgart.de/aVI CE Contractile element
IVFE Intervertebral flexionextension
T. K. Rupp W. Ehlers N. Karajan S. Schmitt ROM Range of motion
Cluster of Excellence for Simulation Technology (SimTech),
University of Stuttgart, Pfaffenwaldring 5a,
ALL Anterior longitudinal ligament
70569 Stuttgart, Germany PLL Posterior longitudinal ligament
URL: http://www.simtech.uni-stuttgart.de LF Ligamentum flavum
SSL Supraspinal ligament
W. Ehlers N. Karajan
Institute of Applied Mechanics (Civil Engineering), University
ISL Interspinal ligament
of Stuttgart, Pfaffenwaldring 7, 70569 Stuttgart, Germany RA Rectus abdominis muscle
URL: http://www.mechbau.uni-stuttgart.de/ls2 EO External oblique muscle
IO Internal oblique muscle
N. Karajan
DYNAmore GmbH - Gesellschaft fr FEM Ingenieurdienstleistungen,
PM Psoas major muscle
Headquarter, Industriestr. 2, 70569 Stuttgart, Germany MF Multifidus
URL: http://www.dynamore.de IT_m Intertransversarii mediales

123

LTpL Longissimus thoracis pars lumborum
IL Iliocostalis lumborum pars lumborum
C1C7 Cervical vertebrae
T1T12 Thoracic vertebrae
L1L5 Lumbar vertebrae
S1S5 Sacral vertebrae
Sagittal axis Dorsal to ventral (= x-axis)
Longitudinal axis Caudal to cranial (= z-axis)
Graphic primitive Geometric primitive, describes the
simplest geometric objects that the
system can handle; in this model, the
graphic primitives represent respec-
tive body segments
1 Introduction
Humans everyday lives lead to frequent impacts on the loco-
motor system. Over time, this causes natural degeneration of
its biological structures, e. g. bones, muscles, and ligaments.
When focussing on the human lumbar spine, degradation of
the intervertebral discs (IVDs) and the vertebral bodies is
the prominent feature of this process (Cassinelli and Kang
2000; Elias 1958; Miller et al. 1988; Sarzi-Puttini et al. 2004;
Whatley and Wen 2012). Yet, cause and effect of biological
degeneration across the lifespan are still under debate.
The evaluation of acting forces and moments within bio-
logical structures while performing dynamic movement can
help in gaining more insight into the mechanisms of natural
degeneration. In vitro and in vivo measurements have been
accompanied by computer simulations (in silico) in order to
determine the internal dynamics of the spine. In contrast to
experimental testing, computer models allow biomechanical
analyses of the spine in a more efficient, ethically acceptable
and completely reproducible manner (Esat and Acar 2008;
Gatton et al. 2011). To achieve this, all relevant structural ele-
ments, e. g. vertebrae, IVDs, spinal ligaments, and muscle
tendon complexes (MTCs); their material properties; and an
appropriate verification of the whole model need to be taken
into account to accurately predict the internal dynamics and
the load distribution of the spine, and to analyse the func-
tionality and purpose of the different biological structures.
Two different modelling and computer simulation
approaches are commonly used for the mechanical analyses
of the spine: multi-body (MB) simulations and simulations
based on the finite-element (FE) method.
On a smaller spatial scale, FE models have been used for
the calculation of internal stresses in vertebral bodies and
IVDs (Ehlers et al. 2008; Schmidt et al. 2007, 2010), and for
virtual prototyping and testing of spinal implants (Rohlmann
et al. 2010). FE models have reached high levels of preci-
sion when applied to individual organs, i.e. simulation results
closely match with in vitro experimental testing (Rohlmann
123
T. K. Rupp et al.
et al. 2009), thereby adequate boundary conditions for vari-
ous life situations (daily activity, physical training, or acci-
dental movements) are indispensable for FE analyses in an
accurate and physiologically valid manner. Yet, in vivo mea-
surements for determining, for instance, forces and moments
acting on the intervertebral discs or forces on vertebral end-
plates as boundary conditions for FE models, have remained
extremely challenging. They have not yet been determined in
a satisfactory manner (Rohlmann et al. 2009; Schmidt et al.
2010).
Musculoskeletal MB models of the spine have been devel-
oped and used on a larger spatial scale to determine spinal
kinematics and loads as well as muscle activation patterns
(de Zee et al. 2007; Stokes and Gardner-Morse 1995). In this
regard, several musculoskeletal MB models of the spine have
been introduced (Cholewicki and McGill 1996; Christophy
et al. 2011; McGill and Norman 1987), thereby challenges
have arisen due to intersubject variability concerning anthro-
pometry, modelling of joints, intervertebral discs, facet joints,
passive ligamentous structures, and active MTCs. Lately,
spinal MB models have shown an increasing level of preci-
sion and complexity. To date, the inverse dynamics approach,
cf. Otten (2003), has been mainly used.
In general, MB models have provided indispensable
options for scientific research to synthesise human movement
(Gnther and Ruder 2003; Hatze 1976, 1981; Pandy et al.
1990; Soest et al. 2003; Van Soest and Bobbert 1993). How-
ever, drawbacks remain when MB models are applied to the
biomechanical analysis of the human spine. Model simplifi-
cations (e. g. model characteristics of structural elements and
lumped modelling of biological structures) restrict detailed
biomechanical analyses of the human spine. Lumped mod-
elling is often found in intervertebral joints, when the IVD,
its surrounding muscles, and ligaments are modelled as one
structural elements (often called bushing element). This way,
it is not possible to investigate different structural elements
of the spine, e. g. their force contribution, functionality, and
purpose, and to assign different features to the involved bio-
logical structures. Furthermore, it can be stated that so far
the linear approach has mainly been used for modelling the
structural elements of the spine, e. g. linear bushing element
(Christophy et al. 2011; de Zee et al. 2007). This is in con-
trast to the nonlinear nature of most biological, structural
elements, e. g. nonlinear forcelength characteristics.
In the presented work, a forward dynamics full human MB
model with a detailed lumbar spine is introduced. The aim
was to investigate the impact of different structural elements
on spinal dynamics and the internal loads of spinal struc-
tures. Consequently, all load-bearing structures, i.e. muscles,
ligaments, and IVDs, were incorporated as separate struc-
tures into the MB model of the spine. Internal kinematics
and the load contribution of different biological structures
were analysed. This allows to synthesise spinal movement
A forward dynamics simulation of human lumbar spine flexion
and to better understand the mechanical degeneration on the
spine. As a consequence, it will be possible to investigate the
mechanical consequences of daily life and spinal pathologies
to evaluate different surgery methods and physical therapies,
as well as to numerically test spinal implants in an accurate
and physiologically valid manner. We provide the MB model
implemented in C/C++ and the binaries needed for our in-
house MB simulation code demoa as electronic supplemen-
tary material and hope that this facilitates the biomechanical
research on spinal dynamics.
2 Material and methods
A full human MB model with a detailed lumbar spine was
developed. The model is driven by the stimulation of muscles.
Back muscles in the lumbar region, abdominal muscles, and
leg muscles were modelled as Hill-type muscles (Gnther
et al. 2007; Mrl et al. 2012; Schmitt et al. 2012). Nonlin-
ear ligaments were included in the lumbar spine. The leg
segments (feet, shanks, thighs) were connected to each other
and the pelvis segment by hinge joints. Adjacent vertebrae as
well as L5 and the pelvis were connected to each other by free
joints (6 degrees of freedom (DOF)) equipped with IVD force
elements. Currently, the full human model has 42 (6 hinge,
6 free joints) mechanical DOFs and 404 additional DOFs in
the 202 (70 leg, 84 lumbar spine, 48 abdomen) MTCs.
Modelling and simulation was done with the authors in-
house MB simulation code demoa, cf. Henze (2002), Schmitt
(2003). Demoa includes the biomechanical preprocessor cal-
cman, the simulation framework sim, and the animation tool
ani.
Calcman has been developed to calculate subject-derived
anthropometric data sets. These are used as an input and basis
for human MB models. The calculated data sets are based on
statistical anthropometric data sets from the literature (DIN
1986; NASA 1978). Calcman uses three input parameters
(mass, sex, and height) to calculate a subject-derived anthro-
pometric data set. Each data set consists of segment para-
meters defining the model segments (bodies): length, mass,
moment of inertia, position, and orientation of its centre of
gravity and joint centre, as well as width, depth, and circum-
ference. Calcman writes the respective kinematic chain as
an output. In this work, calcman was extended to generate a
subject-derived geometrical data set of the lumbar spine and
torso (see Sect. 2.1).
In addition to the geometrical model, (visco-)elastic char-
acteristics of biological tissue, as for example ligaments or
external contacts, are described and modelled as force ele-
ments, acting on the geometry.
Simulations are performed using sim. The mechanics
in sim is based on a derivation-free formulation of the
Lagrangian equations in generalised coordinates. This
method uses a homogeneous matrix transformation approach
proposed by Denavit et al. (1965), Denavit and Hartenberg
(1955). It was extended by Legnani et al. (1996a, b) with
the introduction of new homogeneous matrices to describe
the velocity and the acceleration, the momentum, the iner-
tia of bodies, and the actions (forces and moments) applied
to them, both translational and rotational. The method is
embraced and implemented in SpaceLib , a library for
three-dimensional dynamics of rigid body systems, that was
used in demoa (see provided C/C++ code and Henze (2002),
Schmitt (2003) for a detailed description of the mathematical
formulation and usage within demoa).
2.1 Model geometry
Our spine model consists of seven rigid segments: the pelvis,
the five lumbar vertebrae, and a lumped thoraciccervic
headarms part (upper body, compare Fig. 9). To the best of
our knowledge, a complete anthropometric data set for the
cervical, thoracic, and lumbar spine has not been realised yet.
A scalable anthropometric data set was generated for the
spinal column on the basis of the literature data, i.e. verte-
bral width and depth (cf. Gilad and Nissan 1986; Panjabi
et al. 1992, 1991; White and Panjabi 1990) as well as height
(cf. Busscher et al. (2010); Gilad and Nissan (1986)), ori-
entation, and position (cf. Ashton-Miller and Schultz 1997;
Belytschko 1978; El-Rich and Shirazi-Adl 2004; Kitazaki
and Griffin 1997) of vertebrae. The geometry is assumed to
be symmetrical with respect to the sagittal plane (xz-plane).
The global origin of the model is located in between the two
feet on the ground. The local coordinate system of the body
S1 drops perpendicular through the global origin of the whole
model. The frontal axis in sagittal plane is defined from dor-
sal to ventral. It is equal to the x-axis. The longitudinal axis
is defined from caudal to cranial and is equal to the z-axis.
The generated data set includes position and orientation data
for the lumbar and thoracic spine from S1 to T1 and vertebral
dimensions for all vertebrae from S1 to C3. The generation
of the anthropometric data set is explained in Appendix 1.
Position data and orientation angles of each vertebra for
the modelled subject, i.e. a male subject with mass m = 68kg
and height h = 1.78 m, are depicted in Table 1.
In contrast to the lumbar vertebrae, vertebrae of the tho-
racic and cervical spine were not included as single segments
in our MB model. Instead, they were merged into the so-
called upper body representing the head, the upper arms, the
forearms, and the hands as well as the thoracic and the cervi-
cal vertebrae plus their surrounding soft tissue. The lumped
upper body mass was included as one point mass positioned
in the upper bodys centre of mass, cf. Calisse et al. (1999).
The centre of mass of the upper body was determined on the
basis of the torsos centre of mass (NASA 1978). The NASA
(1978) defines the position of the torsos centre of mass in
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 T. K. Rupp et al.

Table 1 Position and orientation data of each vertebra (centre) for the modelled subject, i.e. a male subject with mass m = 68 kg and height
h = 1.78 m, with respect to the global reference frame (origin between feet, vertical line passing through origin and S1)
Level x (mm) z (m) centre ( ) upper ( ) Level x (mm) z (m) centre ( ) upper ( )

T1 40.20 1.48 23.75 26.8 T10 5.33 1.27 2.57 0.4

T2 31.23 1.46 21.67 26.7 T11 3.19 1.24 5.60 5.6
T3 23.48 1.44 19.92 23.9 T12 0.48 1.21 7.37 9.4
T4 15.93 1.42 17.91 19.9 L1 4.93 1.18 7.04 10.0
T5 9.19 1.39 15.54 15.5 L2 8.64 1.14 3.76 3.8
T6 3.20 1.37 12.53 15.5 L3 9.13 1.10 2.89 0.9
T7 1.29 1.35 9.07 14.1 L4 4.16 1.06 11.71 11.7
T8 4.30 1.32 5.31 10.3 L5 6.16 1.03 18.68 18.7
T9 5.77 1.30 1.21 4.2 S1 0.00 0.95  36.0
The x-value on the frontal axis is calculated using Eq. (2), i.e. its value is determined with respect to the vertebraes position on the longitudinal axis
(z). centre is the orientation angle, i.e. inclination angle of the centre of the vertebral body with the frontal (x). upper is the estimated orientation of
the upper endplate with the sagittal axis. Note that vertebral body S1 does not allow to choose a centre lines orientation due to the fusion of the Os
sacrums bones ()

relation to the waist depth and breadth at omphalion and
the distance between suprasternale and trochanterion. This
point was localised in the presented model, and the upper
bodys mass was calculated. The centre of mass of the upper
body was determined to be positioned 15.1 mm anterior and
6.8 mm cranial to the centre of thoracic vertebra T12 with a
mass of 36.8 kg.
2.2 The spinal ligaments
Five spinal ligaments, i.e. anterior longitudinal (ALL) and
posterior longitudinal ligament (PLL), ligamentum flavum
(LF), supraspinal (SSL), and interspinal (ISL) ligament,
were included as nonlinear model elements at each spinal
level between S1 and L1. The developed nonlinear ligament
model and parameter estimation are described in detail in
Appendix 2.
Attachment points for the four lumbar ligaments were
defined in analogy to Panjabi et al. (1982), Pintar et al. (1992).
Proposed anatomical landmarks were identified on the fitted
graphic primitives from CT data (Anatomium (TM), 21st
Century Solutions Ltd/Gibraltar). Additionally, ALL, LF,
and ISL were approximated by multiple lines for one liga-
ment (multiple ligament parts). PLL and SSL were modelled
by one single line.
The parameters FA , lA , FB , lB , lLIG,0 , ULIG,nll , ULIG,l ,
FLIG,0 , LIG,nll , and pre-strain data of the included spinal
ligaments are depicted in Table 5 (Appendix 3).
2.3 Joints and the nonlinear intervertebral disc model
Human vertebrae are connected by IVDs that allow each
vertebra to move in six DOFs. A detailed description of the
development of the nonlinear IVD model used here can be
found in Appendix 4. The nonlinear IVD model consists of
a third-order polynomial for each DOF to capture the elastic
mechanical response of each lumbar IVD, viz.
FIVD-nl,x = 14.548 Nm3 r x3 + 0.4186 Nm2 r x2
+ 43.764 Nm1 r x ,
FIVD-nl,y = 14.548 Nm3 r y3 0.4186 Nm2 r y2
+ 43.764 Nm1 r y ,
FIVD-nl,z = 32.432 Nm3 r z3 65.925 Nm2 r z2
+ 380.96 Nm1 r z ,
MIVD-nl,x = 1.6 Nm/deg x ,
MIVD-nl,y = 0.0046 Nm/deg3 y3 0.0001 Nm/deg2
y2 + 1.0158 Nm/deg1 y ,
MIVD-nl,z = 6.9 Nm/deg z , (1)
with r x displacement in the direction of the frontal joint axis,
r y displacement in the direction of the transverse joint axis,
r z displacement in the direction of the longitudinal joint axis,
x angle around the frontal joint axis, y angle around the
transverse joint axis, z angle around the longitudinal joint
axis.
Damping forces of the IVD elements were modelled ana-
log to damping forces of ligaments (see Sect. 2.2). Linear
stiffness parameters were taken from other multi-body mod-
els (Huynh et al. 2010; Monteiro 2009) and one experimen-
tal data set in its non-coupled version (Gardner-Morse and
Stokes 2004). They were used to implement linear IVDs for
comparison with our new nonlinear IVD model. The linear
stiffness parameters are listed in Table 2.
2.4 The abdominal and lumbar back muscles
The incorporation of the muscle groups into the lumbar spine
model is depicted in Fig. 1.

123
A forward dynamics simulation of human lumbar spine flexion
Table 2 Stiffness parameters for rotational and translational movement of IVDs extracted from linear IVD models
Stiffness parameters Huynh et al. (2010)
Anterior shear (N/m) 150,000.0
Lateral shear (N/m) 150,000.0
Compression (N/m) 650,000.0
Lateral bending (N/ ) 1.6
Flexion (N/ ) 1.4
Axial rotation (N/ ) 6.9
GM: Gardner-Morse and Stokes (2004), H: Huynh et al. (2010), M: Monteiro (2009). Please note () that Monteiro (2009) indicates the rotational
stiffness in (Nm/rad). However, we think that this is a typographical error in the respective article and should be corrected to (Nm/deg)
According to Bogduk (2005), lumbar back muscles are
such muscles that exert an action on the lumbar spine and lie
behind the plane of transverse processes, i.e. interspinales,
intertransversarii mediales, multifidus, and lumbar erector
spinae (lumbar and thoracic part). Our spine model features
these lumbar back muscles except for the thoracic part of the
lumbar erector spinae and the interspinales. Additionally, the
rectus abdominis, the psoas major as well as the internal and
external obliques were implemented as abdominal muscles.
The transversus muscle was not included as it is the smallest
of the abdominal muscles without an anterior attachment to
the skeleton and because it has a very curved line of action
(Stokes and Gardner-Morse 1999). Redirection of muscle
lines of action has not been implemented in demoa so far.
A more detailed description including attachment points
of included muscle fibres is given in Appendices 5 and 6.
The intertransversarii mediales is a short intersegmental
muscle connecting adjacent lumbar vertebrae. Attachment
points of the four lumbar muscle pairs for the intertransver-
sarii mediales were identified according to Bogduk (2005).
Again, proposed anatomical landmarks were identified on
the fitted graphic primitives.
The multifidus is the largest and most medial muscle that
spans the lumbosacral junction. It consists of multiple fas-
cicles radiating from the lumbar spinous processes and lam-
inae. 25 fascicles in three layers arising from each lumbar
vertebra were implemented in the model on each side accord-
ing to Bogduk et al. (1992), Macintosh and Bogduk (1986),
Macintosh et al. (1986).
The lumbar erector spinae is positioned lateral to the multi-
fidus. Two muscles, i.e. the longissimus thoracis and the ilio-
costalis lumborum, compose the erector spinae in the lumbar
region. Each muscle has a lumbar part (longissimus thoracis
pars lumborum, ilicostalis lumborum pars lumborum) and a
thoracic part (longissimus thoracis pars thoracis, ilicostalis
lumborum pars thoracis) (Bogduk 2005). While the fascicles
of the lumbar part arise from lumbar vertebrae, the fascicles
of the thoracic part arise from thoracic vertebrae and the ribs.
Hence, the latter were not included in the model. Five fas-
cicles of the longissimus thoracis pars lumborum and four
Monteiro (2009) Gardner-Morse and Stokes (2004)
260,000.0 57,730.0
260,000.0 74,700.0
1,825,000.0 405,150.0
4.57 0.92
3.88 0.87
9.82 0.85
fascicles of the ilicostalis lumborum pars lumborum were
included on each side of the spine model. Here, we adopted
the description of Bogduk et al. (1992), Macintosh and Bog-
duk (1987, 1991).
The psoas major arises from the anterolateral aspect of
the lumbar spine, i.e. from the lumbar vertebral bodies, their
transverse processes and the IVDs in between. Distally, its
fascicles have a common tendon that passes over the ilium
and inserts at the lesser trochanter of the femur. Hence, it was
attached to the vertebral bodies, to the transverse processes,
and to the iliopubic eminence (pelvis), following the descrip-
tion of Stokes and Gardner-Morse (1999).
The rectus abdominis is a medial strap-like muscle extend-
ing caudocranially from the pubis to the sternum. Two fas-
cicles were included according to the description of Bogduk
et al. (1992), Stokes and Gardner-Morse (1999), and Wilken-
feld et al. (2006).
The external oblique is the most superficial muscle of the
lateral abdominal wall with the internal oblique lying beneath
it. Six fascicles each, running anteriorly and downward in the
external oblique and anteriorly and upward in the internal
oblique, were included based on the descriptions of Stokes
and Gardner-Morse (1999).
Muscles were modelled as Hill-type MTCs in the pre-
sented model. See Appendix 5 for a short description and
Gnther et al. (2007), Haeufle et al. (2014), Mrl et al. (2012)
for a detailed description of the muscle model.
Input parameters for each MTC model structure are max-
imum isometric force of the contractile element (CE) Fmax ,
optimal fibre length lCE,opt , and rest length of the serial elas-
tic element lSEE,0 . All other input parameter values can be
set to generic values in a first approximation as in Mrl et al.
(2012), which mainly refers to Gnther et al. (2007). The
MTC-specific values, Fmax , and the ratio of the muscle fibre
length to the MTC length in an upright position of the lum-
bar spine m ratio = lCE,opt /lMTC,upright were adopted from the
literature (Christophy et al. 2011; Daggfeldt and Thorstens-
son 2003; Delp et al. 2001; Macintosh and Bogduk 1987;
Rosatelli et al. 2008). Muscle fibre length in upright position
was set to lCE,upright = m ratio lMTC,upright , with lMTC,upright
123

Fig. 1 Muscle groups implemented in the spine model for the (A)
abdominal muscles (psoas major, rectus abdominis, internal and exter-
nal oblique muscle), (B) multifidus, and (C) lumbar erector spinae.
Graphic primitives from CT data (Anatomium (TM), 21st Century Solu-
tions Ltd/Gibraltar) were used to represent the modelled body segments
123
T. K. Rupp et al.
adapted from the spine models geometry in upright position.
For all muscles, it was assumed that lCE,upright = lCE,opt and
lSEE,0 = lMTC,upright lCE,upright . All muscle parameters are
depicted in Table 6 (Appendix 6).
2.5 Lower extremity model
The lower extremity model consists of two feet, two shanks,
two thighs, and the pelvis. It was connected to the spine model
with a free joint and IVD or bushing element between pelvis
and L5. All other joints in the lower extremity model, i.e.
talocrural, knee, and hip joint, were modelled as hinge joints.
Human stance control was implemented as if the model was
only two-dimensional in the sagittal plane. Three contact
points at each foot together with a biomechanical contact
model represented ground contact, cf. Gnther and Ruder
(2003). All in all, 70 MTCs were included in the lower
extremities. Stance control was based on the -model ver-
sion of the equilibrium point theory published by Feldman
and Levin (2009) and Feldman (1986) and restricted to the
muscles in the lower extremity. For implementation details,
please refer to Gnther and Ruder (2003), Kistemaker et al.
(2007).
2.6 Simulation
We present a new, nonlinear lumbar spine model with all
above-described spine model structures included (vertebral
bodies, ligaments, MTCs, IVDs). Additionally, we used a
state-of-the-art linear bushing element as an IVD model
variation to compare with our nonlinear IVD model (see
Sect. 2.3). Simulations of simple flexion movements in the
sagittal plane were performed with both models. The spine
model is only driven by the stimulation input STIM of the
muscles. Stimulation input for the muscles was preset to
STIMabdominal = 0.2 for the abdominal and STIMback =
0.05 for the back muscles. Remember that stimulation input
for the lower extremity muscles (STIMlowext ) was calculated
using the -control model and a very simple approach for
human stance control (Gnther et al. 2012) (see Appendix 5
(Eq. 71 ) and 2.5).
The simulation was started from an initial, upright
stance position (see 2.1) with both feet just about to touch
the ground. From there, the model settled into a quasi-
equilibrium state, which represents our initial condition. This
state was assumed to be reached when the vertical con-
tact
6 forces (three contacts in each foot) had leveled off at
i=1 Fcontact,i [0.95 m ges , 1.05 m ges ] for at least
1 ms of simulation time. The model state at settling time
t = tSET = tsim,start was still a neutral, upright stance posi-
tion. The muscle-mechanical state at t = tSET was used as an
initial condition for all simulations analysed in the follow-
A forward dynamics simulation of human lumbar spine flexion

ing. Furthermore, the ligaments rest lengths were adjusted A 15

to this settled state (see Appendix 2).
The end of each simulation (t = tsim,end ) is defined as

lumbar lordosis angle L []

10
the time when the heels start lifting off the ground after the L=17.68
subject has performed a flexion movement. This is when the
vertical components of the contact forces are zero for a short 5
instance of time (Fcontact,heel = 0 N at t = tsim,end ).

0
3 Results

Our full human model was used for simulating a flexion 5

movement of the spine during upright stance. The simulated 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

movement started in a neutral upright position and ended in t sim [s]

a flexed position (see Sect. 2.6). Spinal and abdominal mus- B 45
cles were stimulated with a constant submaximal stimula-
tion, whereas muscles in both legs were dynamically acti- 40

sagittal flexion angle S []

vated to perform stance control. As simulation results, lum- S =27.00
35
bar kinematics and loads of different biological structures are
presented (see Sect. 3.1). A model comparison between our 30
nonlinear IVD model versus a classical, linear IVD model
quantifies the differences between the two approaches on the 25
human lumbar spine level (see Sect. 3.2).
20
The overall flexion movement is represented by the lum-
bar lordosis (Polly et al. 1996) and the sagittal flexion angles 15
(Gracovetsky et al. 1995) (L , S ). The lumbar lordosis
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
angle was calculated as the difference in global orientation
t sim [s]
angles (in the sagittal plane) of IVD L5/S1 and IVD T12/L1.
Global orientation of each IVD was calculated as the mid- Fig. 2 A Lumbar lordosis angle according to Polly et al. (1996) and
angle between inferior endplate of the respective top vertebra B sagittal flexion angle according to Gracovetsky et al. (1995) as a
and superior endplate of the respective bottom vertebra. The function of the simulation time tsim starting at tSET (tsim = 0 at
tSET , tSET = 0.24 s). Overall simulation time is tsim = 0.62 s, i.e.
sagittal flexion angle is the angle between the global lon-
tsim,start = tSET = 0.24 s, tsim,end = 0.86 s
gitudinal axis (z-axis, normal to the ground) and a straight
line through the centre of S1 and C7 in the sagittal plane
(Gracovetsky et al. 1995). Both angles are depicted in Fig. 2
(see also Fig. 11 in Appendix 7). These numbers are
as a function of the simulation time tsim , i.e. tsim = 0
segmental displacements along the local longitudinal axis
at tSET , tsim,start = tSET = 0.24s, tsim,end = 0.86s and
(z: caudocranial direction) of the subjacent body relative to
tsim = 0.62s. During flexion, the torso is leaning forward
the displacement after settling (rz (t = tSET ) = 0.0 mm).
by S-nl = 27.00 , while the lumbar lordosis increases by
The local rotation angles in all lumbar interspaces increase
L-nl = 17.68 .
from L1/2 to L4/5: y 2.6 . . . 4.6 (see also Fig. 11
In all following figures, the presented results are plotted
in Appendix 7). These values are rotation angles in the
against the negative relative lordosis angle (L ) instead
local sagittal plane of the subjacent body (its local xz-
against simulation time (tsim ). L is the change in angle
plane), i.e. angular displacements between two adjacent ver-
with respect to the initial lordosis angle at time tSET . Joint
tebrae. They are likewise presented relative to rotation at tSET
kinematics and loads are depicted with reference to the local
(y (t = tSET ) = 0 ).
coordinate system of each subjacent body (centre of mass
During the simulated flexion movement, IVD forces along
of the caudal vertebra). In the following, results of the inter-
the local longitudinal axes show an increase from L1/2 to
vertebral joints L4/5 are highlighted in figures by using bold
L4/5: Fz 313N . . . 638 N. IVD moments in the local
lines.
sagittal plane (around y-axis) increase with bending forward
3.1 Simulation results and model prediction from L1/2 to L4/5: My 4.1 Nm . . . 7.5 Nm. IVD forces
and moments are depicted in Fig. 3. Restoring forces in all
The vertical displacements of the segments at t = tsim,end posterior ligaments (PLL, LF, SSL, ISL, see 2.2) during flex-
increase from L1/2 to L4/5: rz 0.34 mm . . .0.62 mm ion increase from L1/2 to L4/5 while forces of the anterior

123
 T. K. Rupp et al.

A 1700
L4/5
A 700
L4/5
1600 L3/4
L3/4
L2/3
restoring force in IVD Fz [N]

600 L2/3

ligament force [N] posterior

1500 L1/2
L1/2

1400 500

1300
400
1200
300
1100

1000 200

900
0 2 4 6 8 10 12 14 16 18 100
0 2 4 6 8 10 12 14 16 18
L[ ]
L[ ]

B 18
L4/5 B 4
L4/5
restoring moment in IVD M y [Nm]

L3/4
16 3.5 L3/4
L2/3

ligament force [N] anterior

L1/2 L2/3
14 3 L1/2

12 2.5

10 2

1.5
8
1
6
0.5
4
0 2 4 6 8 10 12 14 16 18 0
L[ ] 0 2 4 6 8 10 12 14 16 18
L[ ]
Fig. 3 A IVD force components along the local longitudinal axis (z:
caudocranial direction) of the subjacent body and B IVD moments in Fig. 4 Summed total forces Ftot in A posterior and B anterior spinal
the local sagittal plane of the subjacent body (its local xz-plane) as a ligaments as a function of the negative lumbar lordosis angle, with
function of the negative lumbar lordosis angle. Bold lines are used to Ftot = Fel + Fdamp . Bold lines are used to emphasise summed total
emphasise joint forces and moments in L4/5 forces in ligaments surrounding L4/5

ligament (ALL) decrease from L1/2 to L4/5. The cumulated smallest range is depicted for the linear model with stiffness
ligament forces are depicted in Fig. 4. Selected muscle forces parameters according to Monteiro (2009) for both angles,
are depicted in Fig. 5 as forces of the muscletendon com- while the nonlinear and the linear Huynh model present sim-
plexes (FM ) normalised with respect to their respective max- ilar ranges. Larger ranges for both angles are found when
imum isometric force of the contractile element (Fmax ). All using the stiffness parameters proposed by Gardner-Morse
generated muscle forces show values of FM /Fmax < 37.4 %. and Stokes (2004) (see Table 3). Both angles are depicted
Loads are distributed homogeneously between structures. in Fig. 6 as a function of the simulation time tsim , i.e.
tsim = 0 at tSET . The overall simulation time shows lit-
3.2 Model comparison: nonlinear versus linear IVD model tle variations while start and end of each simulation do vary
(see Table 4). Hence, all models result in different lumbar and
Selected results for all linear model variations (GM: Gardner- sagittal movement in a similar period of simulation time.
Morse and Stokes (2004), H: Huynh et al. (2010), M: Mon- During the simulated flexion movement, IVD forces along
teiro (2009), for stiffness parameters, see Table 2) are pre- the local longitudinal axes show an increase in all lumbar
sented and compared to our nonlinear model. They are indi- joints in all model versions. IVD forces are similar in the
cated with nl for the nonlinear (new IVD element) and nonlinear and Huynh model at the start of simulation. Lin-
l_GM , l_H , and l_M for the three linear (bushing element) ear models using stiffness parameters by Gardner-Morse and
MB model versions, respectively. Stokes (2004) or Monteiro (2009) present higher restoring
All model versions show different settling behaviours forces at tsim,start . The Monteiro model shows less overall
with, respectively, different lumbar lordosis and sagittal flex- increase, while all other models predict a greater increase
ion angles (L , S ). The ranges differ for both angles. The in restoring forces, i. e. Fz-nl 313N . . . 638 N ver-

123
A forward dynamics simulation of human lumbar spine flexion

A 20
RA
A 25
nl
EO 20 lGM
F M /Fmax (sum of fascicles) [%]

lumbar lordosis angle L [ ]

18 IO lH
PM 15 lM

16
10

14 5

0
12
5

10 10

8 15
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
0 2 4 6 8 10 12 14 16 18
L[ ] t sim [s]

B 40 B 60
nl
MF
IT_m 55 lGM
35
F M /Fmax (sum of fascicles) [%]

sagittal flexion angle S [ ]

LTpL lH
50
IL lM
30 45

25 40
35
20
30
15
25
10 20

5 15
10
0 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
0 2 4 6 8 10 12 14 16 18
t sim [s]
L[ ]
Fig. 6 A Lumbar lordosis angle according to Polly et al. (1996) and
Fig. 5 FM /Fmax for A each abdominal muscle (grouped fascicles, RA B sagittal flexion angle according to Gracovetsky et al. (1995) as a
rectus abdominis, EO external oblique, IO internal oblique, PM psoas function of the simulation time tsim starting at tSET (tsim = 0 at tSET ,
major) and for B each back muscle (grouped fascicles, MF multifidus, tSET-nl = tSET-l_H = 0.24s, tSET-l_GM = 0.17s, tSET-l_M = 0.31s). All
IT_m intertransversarii mediales, LTpL longissimus thoracis pars lum- model versionsnonlinear (nl, solid line) versus linear (l, dotted and/or
borum, IL iliocostalis lumborum pars lumborum) as a function of the dashed lines)are depicted. The ranges differ for both angles. The
negative lumbar lordosis angle widest range is accomplished in the linear GardnerMorse model for
both angles. The linear Huynh model and the nonlinear model present
Table 3 Ranges of lumbar lordosis and sagittal flexion angles for the a mid-range, while using Monteiro data results in small ranges. Overall
nonlinear (nl) and linear IVD models simulation time is approximately the same in all models
Lumbar lordosis angle Sagittal flexion angle
Table 4 Overall simulation time as well as start and end of simulation
L-nl 17.68 S-nl 27.00 for the nonlinear (nl) and linear IVD models
Ll_GM 26.86 Sl_GM 38.80
Overall simulation time Start and end of simulation
Ll_H 19.03 Sl_H 28.48
Ll_M 6.94 Sl_M 12.90 tsim-nl 0.62s tsim,start-nl 0.24s tsim,end-nl 0.86s
GM: Gardner-Morse and Stokes (2004), H: Huynh et al. (2010), M: tsiml_GM 0.67s tsim,start-l_GM 0.17s tsim,end-l_GM 0.84s
Monteiro (2009) tsim-l_H 0.68s tsim,start-l_H 0.24s tsim,end-l_H 0.92s
tsim-l_H 0.64s tsim,start-l_M 0.31s tsim,end-l_M 0.95s
sus Fz-l_GM 254 N . . . 634 N versus Fz-l_H 260 N GM: Gardner-Morse and Stokes (2004), H: Huynh et al. (2010), M:
. . . 622 N versus Fz-l_M 150 N . . . 241 N. Respective Monteiro (2009)
IVD forces are depicted in Fig. 7.

understanding of spinal degeneration processes. The unavail-

4 Discussion ability of internal load figures in other methods highlights
the importance of the forward dynamics approach as the
Determining the internal dynamics of the human spines bio- most powerful approach to examine the mechanical cause of
logical structures is an essential step that allows enhanced biological degeneration of spinal structures. Therefore, our

123

1700
nl
restoring force in IVD L4/5 Fz [N]
1600 lGM
lH
lM
1500
1400
1300
1200
1100
1000
900
0 2 4 6 8 10
L[ ]
Fig. 7 IVD L4/5 forces along the local longitudinal axis (z: caudocra-
nial direction) of the subjacent body as a function of the negative lumbar
lordosis angle. All model versionsnonlinear (nl, solid line) versus lin-
ear (l, dotted and/or dashed lines)are depicted
goal was to develop a forward dynamics multi-body model
of the human body, including a detailed model of the lum-
bar spine. The muscles of the legs, back, and abdomen and
all spinal ligaments were included. Intervertebral discs were
modelled using a nonlinear, enhanced modelling approach.
Using a detailed and separate model for each relevant bio-
logical structure allows us to investigate the influence and
function of different structural elements. As a result, detailed
dynamics of all modelled structures can be predicted. In con-
trast to inverse dynamic models, no kinematic data at all were
used as an input. Instead, the model is driven by synthetic
muscle stimulation STIM as input. In the presented model,
STIM is set constant for all muscles in the spine region. For
the lower extremities, balanced upright stance, however, is
achieved by calculating STIM with a higher level motor con-
trol model, the -control model. Future studies can elaborate
on different motion generation patterns of STIM in order to
achieve different movements. Hence, the presented full-body
model can be used as a prediction tool for internal dynamics
of the spine.
4.1 The muscles line of action and model scalability
In this study, only a simple movement was investigated: for-
ward bending. The total range of motion (ROM), i.e. the
sagittal flexion angle, was 27.0 for the nonlinear interver-
tebral disc element. This total ROM would already set the
need for the determination of accurate muscular paths for
the long back muscles, for example, by using via-points
algorithms, wrapping surface algorithms, and dynamic
via-points algorithms (Carman and Milburn 2005; Desailly
et al. 2010). However, our model geometrically separated the
long back muscles to several shorter muscles parts (fasci-
cles) connecting less segments, thereby the redirection issue
123
T. K. Rupp et al.
is overcome. Nevertheless, the lack of realistic muscle paths
leads to missing transversal forces on the spinal segments
towards each local rotation centre. Moreover, recent litera-
ture found reduced maximal muscle forces in the event of
transversal loading (Siebert et al. 2014a). In future research,
this model has to be improved by muscles using realistic mus-
cle paths and calculating the influence of transversal forces
on the spine and on the longitudinal muscle forces itself.
So far, scalability and subject-derived parameters of the
developed full human body model have been achieved using
calcman for selected anthropometrical data of the spine. This
12 14 16 18 includes scaling of position and orientation data as well as
partly mass distribution in the human spine. In future work, to
enhance the models subject-derived parameters, the devel-
oped scaling algorithms need to include scaling of verte-
bral dimension, thereby mass scaling should be improved by
including viscera and surrounding tissue mass, separately.
Additionally, scalability of insertion and origin points of lig-
aments and muscles need to be included in calcman. In a
following step, the algorithm needs to include a distinction
between male and female anthropometrical setup. As another
advanced feature to be included in the future, ageing could be
addressed by parameterising plasticity of spinal ligaments,
intervertebral disc characteristics such as calcium content,
signal propagation times in muscles as well as bone density of
vertebrae. These extensions will lead towards well-grounded
subject-derived modelling and enhanced understanding of
spinal degeneration processes in general and with respect to
individuals.
4.2 The nonlinear intervertebral disc model
One special, new feature of the full human model presented,
here, is the nonlinear model of the intervertebral disc. Karajan
et al. (2013) addressed the shortcoming of the classical, linear
approach, the so-called bushing element used to model inter-
vertebral discs by developing an enhanced nonlinear inter-
vertebral disc model. It was shown that the linear approach
can only represent the mechanical response behaviour for a
limited range of translational and rotational displacements
for isolated intervertebral disc models. Simulation results of
our full human body model including the nonlinear interver-
tebral disc model again show significant differences in the
resultant movement compared to a full human body model
including standard, linear intervertebral disc models. How-
ever, even different parameterisations of the linear inter-
vertebral disc model show significant differences in rota-
tional displacement and intervertebral disc forces (compare
Figs. 6, 7), albeit the determination of valid material proper-
ties of a humans intervertebral disc is not standardised. Stiff-
ness parameters are determined by experimental procedures
using complete functional spinal units (Huynh et al. 2010) or
even the whole lumbar spine (Monteiro 2009). Huynh et al.
A forward dynamics simulation of human lumbar spine flexion
(2010) used the lumped stiffness parameters to model the
intervertebral disc and ligaments separately, thereby increas-
ing the overall stiffness. Monteiro (2009) presents a ques-
tionable process of determining the stiffness of a single inter-
vertebral disc from stiffness data of a whole lumbar spine.
Gardner-Morse and Stokes (2004) present measurements to
determine the stiffness of single lumbar intervertebral discs
including surrounding ligaments. They also present percental
changes when removing all ligaments. Comparing the linear
GardnerMorse model and our nonlinear model, we found
our model to be stiffer in total. However, restoring forces
in the nonlinear model are in the same order of magnitude
with in vivo data, whereas restoring forces of the linear
bushing elements according to Gardner-Morse and Stokes
(2004) undershoot these in vivo results. Still, we argue that
a valid comparison between nonlinear and linear interverte-
bral disc models is lacking and can only be accomplished
with improved nonlinear parameters. So far, the nonlinear
intervertebral disc model is based on an idealised geometry,
its inherent inhomogeneous structure is not included, yet.
The determination of nonlinear parameters from experimen-
tal measurements and the proposed homogenisation tech-
nique of Karajan et al. (2013) would overcome these issues.
It needs to be accomplished and used to model an improved
nonlinear intervertebral disc model. Then, nonlinear and lin-
ear intervertebral disc models can be compared in order to
identify the additional value of using nonlinear interverte-
bral disc models in full human body models. Additionally,
the intervertebral disc model needs to be enhanced to rep-
resent the complete spinal motion segment. Therefore, facet
joints have to be included, which play a significant role dur-
ing flexion movement of the spine.
4.3 The load sharing of biological structures during flexion
movement
The biological joint of a spinal segment is a hypothetical
construct. In our model, this joint is composed of pure force
interaction, namely the IVD, the muscles, and the ligaments.
The sum of all forces composing the joint is the net joint
force. We assume this force to act in a virtual joint coordinate
system located between two adjacent vertebrae. Technically,
in multi-body systems, such a biological joint is a 6-DOF
element connecting parent and child bodies. Thereto, a local
joint coordinate system must be defined on each body. We
constructed a corresponding virtual joint coordinate system
by calculating the arithmetic mean for each single component
of adjacent local joint coordinate systems.
Internal force components along the longitudinal axis
(caudocranial) of the virtual joint coordinate system are
depicted for L4/5 in Fig. 8. The caudocranial force carried by
the intervertebral disc in Fig. 8 is almost identical to the IVD
force component in Fig. 3a. Slight differences in the values
1000
internal loads in joint L4/5 Fz,load [N]
500
0
500
1000
MTC
1500 IVD
LIG
tot
2000
0 2 4 6 8 10 12 14 16 18
L[ ]
Fig. 8 Internal load components in joint L4/5, i.e. forces along the lon-
gitudinal axis (caudocranial) of the virtual joint coordinate system pro-
duced by surrounding muscles (MTC), ligaments (LIG), and the IVDs
(IVD) as a function of the negative lumbar lordosis angle. Additionally,
the sum of all internal loads is depicted
exist due to the coordinate transformation between the two
reference systems: local IVD coordinate system in Fig. 3a and
virtual joint coordinate system in Fig. 8. In the hypothetical
case of modelling just one structure for the spinal segment,
e. g. the classical bushing element or an algebraic constraint,
only one joint force would be calculated. This virtual joint
force would be equal to the sum of the forces produced by the
surrounding biological structures, which is depicted by the
red line (tot) in Fig. 8. In the static case, its value would be
exactly the gravitational load due to the masses cranial to L5.
The actual IVD force is 34 times higher than the virtual joint
force. Assuming the virtual joint force to represent the IVD
load would correspondingly underestimate the physiological
load by 34 times.
Considering all single structures of the same type lumped
into their net effect, the internal forces resulting from the 90
MTCs dominate the internal forces carried by the 11 liga-
ment parts crossing the L4/5 joint. Interestingly, this can be
observed, although the corresponding muscle stimulations
STIM are at a sub-maximal level, i.e. 5 % of maximal stimu-
lation for the back muscles and 20 % of maximal stimulation
for the abdominal muscles. The presented spine model would
allow to depict the individual contribution of each modelled
biological element, for example, the M. longissimus thoracis
pars lumborum part crossing the L4/5 joint (LTpL_L4).
4.4 The validation of human full-body models
A proper validation of a musculoskeletal full-body model
of the human body is a difficult task to perform. This task
requires several steps. The explanatory power of the model
crucially depends on the quality of the taken steps. To the
best of our knowledge, not a single musculoskeletal model,
123

including ours, has yet been published that was rigorously
validated against literature or specifically recorded biologi-
cal data. For models, like the one presented, a consistent and
comprehensive data set of a realistic geometry, exact material
properties, unique kinematics, precisely defined (biological)
constraints, exact initial values (potential energy), and pre-
cisely measured loads would be needed.
For the development of our model, we based all geometri-
cal information on the most comprehensive data set available.
To generate a generic geometry of the spine, we had to merge
several data sets (see Appendix 1). Since we have included
Hill-type muscles as biological drives, we used established
model parameters (see Appendices 5, 6). The implemented
muscle model is not able to predict transversal muscle forces
applied to the bodies. This muscle feature has been recently
addressed (Siebert et al. 2014a, b), and future model versions
will incorporate that. Ligaments were modelled based on sin-
gle in vitro experiments (see Appendices 2, 3). All lumbar
intervertebral discs were modelled using a recently published
approach, which is based on a FE model of the L4/5 disc
and calibrated with experimental data. So far, we have not
included any information on how intervertebral disc parame-
ters are scaled along the spinal column. With that in mind,
the stiffness of all intervertebral discs above L4/5 should be
overestimated, and the displacements of the discs are under-
estimated in our result.
Despite the effort of using validated isolated model parts
like spine geometry, MTCs, ligaments, and intervertebral
discs, we cannot assume the validity of the overall model
a priori. This is due to the nonlinear interplay of the model
parts. Additional experiments analysing the complete non-
linear system are inevitably needed in order to compare sim-
ulation with biology. Several studies found in the literature
report on full spinal motion or local spine kinematics, cf.
Hayes et al. (1989), Ibarz et al. (2013), Pearcy and Portek
(1984), White and Panjabi (1990). Some studies have com-
bined global spine kinematic data with local IVD force data,
cf. Wilke et al. (2001, 1999). As already stated, there is
no experimental data set that resolves kinematics and loads
of force-bearing structures composing the biological joints
of the spine. Lacking comprehensive data sets, we com-
pared our model output with the best data sets on local
and global observables available. For a detailed compari-
son of our model output to the literature data, we refer to
Appendix 7. In summary, the comparison reveals that our
predicted longitudinal joint displacements in the spine and
angular displacements of the IVDs tend to be too low, but are
in accordance with the tendency of the recorded amplitudes
to increase from L4/5 to L1/2. However, the most important
comparison with the literature data is based on the prediction
of the longitudinal IVD forces. Wilke et al. (2001), Wilke
et al. (1999) measured intradiscal pressure from which we
calculated longitudinal IVD forces in L4/5 of 774 N900 N
123
T. K. Rupp et al.
in relaxed standing and 1,944 N in a flexed position. Our
model predicts longitudinal IVD forces of 942 N and 1,681 N,
respectively. We conclude that our model can already predict
valid internal loads of the spinal column in standing and in
flexion movements, i.e. in physiological quasi-static condi-
tions.
This prediction of quasi-static conditions was made pos-
sible due to the modelling of realistic mechanical boundary
conditions, physiological parameterisation of all modelled
force-bearing structures, and realistic stimulation input lev-
els. Eventually, our model is intended to be used in a variety
of biological movement tasks, including dynamic loading
conditions. Consequently, we performed a further validation
step. We simulated an impact situation inducing a shock wave
propagation through the body (see Appendix 8). As in the
static condition, the model output is in good accordance with
the literature data. It predicts realistic shock wave propa-
gation velocity along the spinal column and time delays of
acceleration peaks along the whole body.
4.5 Application and use of the presented model
The presented multi-body model can predict internal loads
of the spine. Moreover, it can be used as a technical tool to
understand the biomechanical design of the human lumbar
spine. The field of application is wide. The model can be used
to determine internal spinal loads for different movements,
for example, by including a more complex movement con-
trol. It can be used for surgery research, for example, a spinal
fusion can be simulated by limiting the degrees of freedom
between two vertebrae. It can be used to test the effect of
intervertebral disc implants, if they are modelled as a com-
plex force element similar to our intervertebral disc model.
It can also be used to study ageing. For this, the parameter-
isation of the modelled biological structures can be varied
to match that of a very old person. Then, the resulting dif-
ferences in internal loads can be examined. Altogether, the
forward dynamics approach as presented here may lead to
an enhanced understanding of mechanical cause of biologi-
cal degeneration or so-called natural ageing.
Back pain is not understood, yet (Hancock et al. 2011;
Langevin and Sherman 2007; Waddell 1987), albeit a direct
relationship between back pain and biological degeneration
has been hypothesised (Millecamps et al. 2012), although not
been proven true so far. This study aimed at providing a con-
sistent, detailed, and quantitative data set of all mechanical
variables that might determine biological degeneration, with
the presented model is possible to quantify forces, stresses,
strains, and rates thereof, as well as repetitive load profiles
acting on structures. For example, we doubt that increased
longitudinal loads automatically result in increased proba-
bility of negative physiological effects, i.e. wear and tear.
Intervertebral disc material might be more sensitive to shear
A forward dynamics simulation of human lumbar spine flexion

450
strain than to axial strain, with a higher risk of failure. This
model can be used as a starting point model to include pain
models in order to contribute towards pain research in the
future. 400
For all mentioned reasons, we provide the developed
multi-body model as C/C++ code as well as the sim- and ani-
binaries of our multi-body simulation package demoa under 350
the BSD License (see electronic supplementary material) to
be used by all researchers in further studies.
300
Acknowledgments The authors would like to thank the German
Research Foundation (DFG) for financial support of the project within
the Cluster of Excellence in Simulation Technology (EXC 310/1) at the

z [mm] longitudinal axis

University of Stuttgart.
T.R. and S.S. have received funding from the (European Union) Seventh 250
Framework Programme (FP7/20072013) under Grant Agreement No.
246994.

200

Appendix 1: Generated anthropometric data set:

vertebral position, orientation, and dimension
150

An average data set of vertebral positions was calculated

from the literature data (Ashton-Miller and Schultz 1997;
Belytschko 1978; El-Rich and Shirazi-Adl 2004; Kitazaki 100

and Griffin 1997) to be used by calcman. They determined

global orientation and position of vertebrae using skin mark-
ers. The vertebral position is defined as the position of the fAvg (z)
50 fAvg (z) +/
geometric centre of each vertebral body with respect to the fAshton (z)
fBelytschko (z)
global reference frame. S1 was positioned in the centre of fKitazaki (z)
the pelvis. Position data from each literature data set was 0
fRich (z)
normalised in length to one reference trunk height, i.e. each 60 45 30 15 0 15
data set was normalised to the same caudocranial distance (z- x [mm] sagittal axis
value) of T1-L5, h T1-L5,Avg = 458.1mm h T1-L5,Belytschko .
Fig. 9 Anthropometric data set functions fitted to the position data
Then, a polynomial fit was estimated for each data set (see of vertebral bodies (centre) in healthy male humans. All polyno-
Fig. 9, f Ashton , f Belytschko , f Rich and f Kitazaki ). These four fits mial fits f Ashton (z) (Ashton-Miller and Schultz 1997), f Belytschko (z)
for x = f (z) were averaged by calculating the mean coeffi- (Belytschko 1978), f Rich (z) (El-Rich and Shirazi-Adl 2004), and
cients of each polynomial. The resulting function (sixth-order f Kitazaki (z) (Kitazaki and Griffin 1997) were scaled to the reference
height of h T1-L5,Avg = 458.1 mm from T1 to L5. f Avg (z) depicts the
polynomial) writes mean data set used for scaling in calcman, the thin grey lines capture
its standard deviation f Avg (z) + / . Plus sign indicates the position
f Avg (z) = 0.015 mm+0.201z 1.12 103 mm1 z 2 of each vertebral centre L5 to T1. The origin is equal to the position
1.2105 mm2 z 3 +7.0108 mm3 z 4 point of L5. The sagittal axis from dorsal to ventral is equal to the x-
axis, while the longitudinal axis from caudal to cranial is equal to the
1.5 1010 mm4 z 5 z-axis
+1.01013 mm5 z 6 . (2)

The average position data on the longitudinal axis includ-
ing standard deviation and the basis data sets are presented
in Fig. 9. Calcman calculates the subject-derived height
(h T1-L5 ) and, with that, scales the z-position of each vertebra
by the ratio h T1-L5 / h T1-L5,Avg while leaving the x-position
unscaled (Table 1).
Each vertebral orientation was defined as the normal of
the curve (Eq. 2) at its position aligning with the anterior
posterior direction of the vertebra. Each vertebra was
modelled as a cylinder (see below), although real ver-
tebrae are slightly wedge-shaped. The calculated orien-
tations were compared with the experimental data from
the literature (Ashton-Miller and Schultz 1997; Campbell-
Kyureghyan et al. 2005), which are usually presented
as upper endplate orientations in the sagittal plane. For
this, we fitted graphic primitives from computed tomogra-
phy (CT) data (Anatomium (TM), 21st Century Solutions
Ltd/Gibraltar) that represent T1 to S1, to their respective

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 T. K. Rupp et al.

cylinder primitives and estimated the upper endplate orien-

tation (Table 1). All three data sets vary locally in the range
of a few degrees, which is well represented by their standard
deviations.
Vertebral dimensions, i.e. vertebral height, depth, and
width, were determined for the entire spine, i.e. C3 to S1.
The study by Gilad and Nissan (1986) was used as a basis.
However, it only includes cervical and lumbar dimensions.
Missing data were determined by parameter scaling of data
sets from Panjabi et al. (1991, 1992), White and Panjabi
(1990). For example, depths for the whole spine included in
Panjabi et al. (1992, 1991), White and Panjabi (1990) were
scaled to the basis depths in Gilad and Nissan (1986) in order
to determine missing vertebral depths in the thoracic spine.
The cylinders height was set to the maximum of dor-
sal and ventral height (Eq. 35 ), its radius to the maximum
of depth and width (Eq. 36 ). This allows an easy inclusion
of the mass of the spinous and transverse processes. It is Fig. 10 Forcelength relation of the spinal ligament. Four independent
parameters were used such as lLIG,0 (rest length), ULIG,nll (relative
assumed that their mass approximately balances the over- stretch at nonlinearlinear transition), FLIG,0 (both force at the tran-
estimation by using the maximum height and ignoring the sition and force increase in the linear part), and ULIG,l (relative addi-
wedge shape of each vertebral body. The vertebral mass tional stretch in the linear part providing a force increase in FLIG,0 ).
(Eq. 33 ) was calculated on the basis of each cylinders vol- The transition between the initial nonlinear and the linear region is
located at lLIG,nll = (1 + ULIG,nll ), the exponent for the initial nonlin-
ume (Eq. 34 ) and the lumbar vertebrae bone density lumbar = ear relation is LIG,nll = ULIG,nll /ULIG,l . The parameters of relevant
6001,000 kg/m3 (Nigg and Herzog 2007). The moment of and included spinal ligaments are given in Table 5. They were derived
inertia tensor follows from the cylinders parameters (see from experimental data (Chazal et al. 1985)
Eqs. (3)1,2 ):
Fel,LIG (lLIG )

Icyl,xx = Icyl,yy = 1/12 m vert,i h 2vert,i + 1/4 0 lLIG < lLIG,0
m vert,i rvert,i
2
, = K LIG,nl (lLIG lLIG,0 )LIG,nll lLIG < lLIG,nll ,

FLIG,0 + K LIG,l (lLIG lLIG,nll ) lLIG lLIG,nll
Icyl,zz = 1/2 m vert,i rvert,i
2
(4)
with m vert,i = Vvert,i lumbar 3/2,
Vvert,i = rvert,i,width
2
h vert,i , where lLIG is its length. Its parameters are
h vert,i = max{h vert,i,dorsal , h vert,i,ventral }, lLIG,nll = (1 + ULIG,nll ) lLIG,0 ,
rvert,i = max{rvert,i,depth , rvert,i,width }. (3) LIG,nll = ULIG,nll /ULIG,l ,
K LIG,nl = FLIG,0 /(ULIG,nll lLIG,0 )LIG,nll ,
K LIG,l = FLIG,0 /(ULIG,l lLIG,0 ). (5)
Appendix 2: Nonlinear ligament model They were derived from four independent parameters such
as lLIG,0 (rest length of ligament), ULIG,nll (relative stretch
Various studies on ligaments confirm a nonlinear stress at nonlinearlinear transition), FLIG,0 (both force at transi-
strain characteristic for ligaments (Chazal et al. 1985; Pin- tion and force increase in linear part), and ULIG,l (relative
tar et al. 1992). For our lumbar spine model, the spinal lig- additional stretch in linear part providing the force increase
aments were modelled as nonlinear straight-line elements FLIG,0 ), cf. Fig. 10. These parameters were partly extracted
based on the experimental results by Chazal et al. (1985), from tensile experiments on 43 human spinal ligaments per-
Panjabi et al. (1982). The function describing the spinal liga- formed by Chazal et al. (1985). For five spinal ligaments, i.e.
ments stressstrain characteristics was assumed to be contin- anterior longitudinal (ALL) and posterior longitudinal lig-
uously differentiable (C 1 continuity) between an initial non- ament (PLL), ligamentum flavum (LF), supra-spinal (SSL),
linear region (up to A) and a constant stiffness at higher loads and interspinal (ISL) ligament, Chazal et al. (1985) estimated
(A-B, see Fig. 10). The concave region at even higher forces tension and elongation at transition (point A), at the end of
is not shown here. Hence, the forcelength characteristic of the linear phase (point B) and at the apex of the tension elon-
a spinal ligament is modelled as gation curve. The arithmetic means of the extracted force and

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A forward dynamics simulation of human lumbar spine flexion

elongation data at A and B (FA , lA , FB , lB ) were used to cal- is then equally distributed by equally distributing FLIG,0
culate three input parameters of the ligament characteristic between multiple lines.
(ULIG,nll , ULIG,l , FLIG,0 ). These input parameters were A velocity-dependent damper was also included in order to
determined separately for each of the five ligaments. account for the ligaments nonlinear viscoelastic behaviour,
The ligaments rest length (lLIG,0 ) was extracted from the i.e.
models geometry. It is accepted that spinal ligaments are
not in a strain-free state when the spine is in its neutral Fdamp,LIG = Fel,LIG dLIG vLIG with
anatomical position during upright stance. Pre-strain data for dlLIG(t)
with vLIG = , dLIG = 1.0 s m1
the spinal ligaments were taken from the literature (Aspden dt
1992; Nachemson and Evans 1968; Robertson et al. 2013) and consequently Ftot,LIG = Fel,LIG (1 + dLIG vLIG ).
and used to determine the ligaments rest length in the neutral (6)
position. The neutral position was approximated by simulat-
ing an initial settling of the lumbar spine model (see 2.6, neu- According to Gerritsen et al. (1995), the damping force
tral position). In that state, each ligaments rest length was depends on the elastic force Fel,LIG and is scaled by a damp-
calculated by the distance between two ligaments attach- ing coefficient dLIG . This avoids discontinuity and numerical
ment points (lLIG,SET [m]) and the respective pre-strain (LIG stabilities.
[ ]): lLIG,0 = lLIG,SET /(1 + LIG ).
As proposed by Panjabi et al. (1982), ligaments with pla-
nar attachment areas, like the ALL, LF, and ISL, can be Appendix 3: Ligament parameters
approximated by more than one pair of attachment points, i.e.
multiple lines for one ligament. Their characteristic (Eq. 4) See Table 5.

Table 5 Ligament modelling parameters for the nonlinear MB model providing the force increase FLIG,0 ) and  (pre-strain of ligament), for
version, i.e. lLIG,0 (rest length of ligament), ULIG,nll (relative stretch at all included spinal ligaments, i.e. anterior longitudinal (ALL) and poste-
nonlinearlinear transition), FLIG,0 (both force at transition and force rior longitudinal ligament (PLL), ligamentum flavum (LF), supraspinal
increase in linear part), ULIG,l (relative additional stretch in linear part (SSL), and interspinal (ISL) ligament
Ligament Name of ligaments Non-lin/IVD
single or multiple line
lLIG,0 (m) ULIG,nll K LIG,nl (N/m2.5 )

ALL lA =1.5 mm, lB =5.0 mm, FA = 55 N, FB = 456 N,  = 6.8 %

LIG,nll = 3.203, K LIG,l =3.9104 N/m
Ligament_S1_L5_ALL_lig1 0.013036 0.116600 1.95 1010
Ligament_L5_L4_ALL_lig1 0.008311 0.182894 1.95 1010
Ligament_L4_L3_ALL_lig1 0.008846 0.171823 1.95 1010
Ligament_L3_L2_ALL_lig1 0.009805 0.155019 1.95 1010
Ligament_L2_L1_ALL_lig1 0.008630 0.176131 1.95 1010
Ligament_S1_L5_ALL_lig2 0.012268 0.123897 1.95 1010
Ligament_L5_L4_ALL_lig2 0.007993 0.190175 1.95 1010
Ligament_L4_L3_ALL_lig2 0.008999 0.168900 1.95 1010
Ligament_L3_L2_ALL_lig2 0.009793 0.155217 1.95 1010
Ligament_L2_L1_ALL_lig2 0.008952 0.169803 1.95 1010
Ligament_S1_L5_ALL_lig3 0.013036 0.116600 1.95 1010
Ligament_L5_L4_ALL_lig3 0.008311 0.182894 1.95 1010
Ligament_L4_L3_ALL_lig3 0.008846 0.171823 1.95 1010
Ligament_L3_L2_ALL_lig3 0.009805 0.155019 1.95 1010
Ligament_L2_L1_ALL_lig3 0.008630 0.176131 1.95 1010

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 T. K. Rupp et al.

Table 5 continued
Ligament Name of ligaments Non-lin/IVD
single or multiple line
lLIG,0 (m) ULIG,nll K LIG,nl (N/m2.5 )

PLL lA = 0.9 mm, lB = 3.2 mm, FA = 48.33 N, FB = 342.5 N,  = 13.0 %

LIG,nll = 2.409, K LIG,l = 12.7 104 N/m
Ligament_S1_L5_PLL_lig 0.044567 0.020569 1.00 109
Ligament_L5_L4_PLL_lig 0.008537 0.107381 1.00 109
Ligament_L4_L3_PLL_lig 0.007142 0.128359 1.00 109
Ligament_L3_L2_PLL_lig 0.009610 0.095393 1.00 109
Ligament_L2_L1_PLL_lig 0.010251 0.089428 1.00 109
LF lA = 1.6 mm, lB = 3.8 mm, FA = 75 N, FB = 315 N,  = 10.0 %
LIG,nll = 2.327, K LIG,l = 3.6 104 N/m
Ligament_S1_L5_LF_lig1 0.023005 0.069549 8.03 107
Ligament_L5_L4_LF_lig1 0.017324 0.092355 8.03 107
Ligament_L4_L3_LF_lig1 0.020142 0.079437 8.03 107
Ligament_L3_L2_LF_lig1 0.021107 0.075805 8.03 107
Ligament_L2_L1_LF_lig1 0.023853 0.067077 8.03 107
Ligament_S1_L5_LF_lig2 0.025083 0.063789 8.03 107
Ligament_L5_L4_LF_lig2 0.017671 0.090542 8.03 107
Ligament_L4_L3_LF_lig2 0.020141 0.079441 8.03 107
Ligament_L3_L2_LF_lig2 0.021098 0.075835 8.03 107
Ligament_L2_L1_LF_lig2 0.023958 0.066783 8.03 107
Ligament_S1_L5_LF_lig3 0.023005 0.069549 8.03 107
Ligament_L5_L4_LF_lig3 0.017324 0.092355 8.03 107
Ligament_L4_L3_LF_lig3 0.020142 0.079437 8.03 107
Ligament_L3_L2_LF_lig3 0.021107 0.075805 8.03 107
Ligament_L2_L1_LF_lig3 0.023853 0.067077 8.03 107
ISL lA = 1.5 mm, lB = 3.8 mm, FA = 40.14 N, FB = 215 N,  = 4.6 %
LIG,nll = 2.960, K LIG,l = 2.6 104 N/m
Ligament_S1_L5_ISL_lig1 0.023083 0.066846 2.81 109
Ligament_L5_L4_ISL_lig1 0.012625 0.122221 2.81 109
Ligament_L4_L3_ISL_lig1 0.016457 0.093759 2.81 109
Ligament_L3_L2_ISL_lig1 0.018955 0.081402 2.81 109
Ligament_L2_L1_ISL_lig1 0.025347 0.060875 2.81 109
Ligament_S1_L5_ISL_lig2 0.023501 0.065657 2.81 109
Ligament_L5_L4_ISL_lig2 0.011996 0.128628 2.81 109
Ligament_L4_L3_ISL_lig2 0.014388 0.107241 2.81 109
Ligament_L3_L2_ISL_lig2 0.018647 0.082747 2.81 109
Ligament_L2_L1_ISL_lig2 0.025289 0.061014 2.81 109
Ligament_S1_L5_ISL_lig3 0.022529 0.068489 2.81 109
Ligament_L5_L4_ISL_lig3 0.011197 0.137807 2.81 109
Ligament_L4_L3_ISL_lig3 0.013926 0.110797 2.81 109
Ligament_L3_L2_ISL_lig3 0.018295 0.084339 2.81 109
Ligament_L2_L1_ISL_lig3 0.026143 0.059021 2.81 109

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A forward dynamics simulation of human lumbar spine flexion

Table 5 continued
Ligament Name of ligaments Non-lin/IVD
single or multiple line
lLIG,0 (m) ULIG,nll K LIG,nl (N/m2.5 )

SSL lA = 1.5 mm, lB = 3.8 mm, FA = 40.14 N, FB = 215 N,  = 12.0 %

LIG,nll = 2.960, K LIG,l = 7.7 104 N/m
Ligament_S4_S3_SSL_lig 0.029616 0.052100 8.42 109
Ligament_S3_S2_SSL_lig 0.036568 0.042195 8.42 109
Ligament_S2_S1_SSL_lig 0.034092 0.045260 8.42 109
Ligament_S1_L5_SSL_lig 0.039796 0.038773 8.42 109
Ligament_L5_L4_SSL_lig 0.039338 0.039224 8.42 109
Ligament_L4_L3_SSL_lig 0.034178 0.045146 8.42 109
Ligament_L3_L2_SSL_lig 0.037396 0.041261 8.42 109
Ligament_L2_L1_SSL_lig 0.054495 0.028314 8.42 109
Pre-strain data for all relevant spinal ligaments were taken from the literature (Aspden 1992; Nachemson and Evans 1968; Robertson et al. 2013).
The remaining four parameters were derived using experimental data from tensile tests (Chazal et al. 1985). Here, force and elongation at transition
(FA , lA ) and at the end of the linear phase (FB , lB ) were used

Appendix 4: Development of specific IVD model
In MB models, IVDs are either modelled as one force ele-
ment or one force element is used to capture the mechanical
response of the IVD as well as its surrounding ligaments and
muscles, i.e. lumped modelling approach for one functional
spinal unit. The mechanical response of an IVD (Huynh et al.
2010) or a functional spinal unit (Christophy et al. 2011;
Monteiro 2009) is usually modelled using a linear and decou-
pled bushing element (6-DOF spring-dashpot element) as a
connecting force element. Stiffness and damping parameters
are taken from experimental measurements (Ashton-Miller
and Schultz 1997; Berkson et al. 1979; Eberlein et al. 2004;
Gardner-Morse and Stokes 2004; Hirsch and Nachemson
1954; Schultz et al. 1979; Virgin 1951). Experimental data
clearly demonstrate the nonlinear nature of these biological
tissues. Hence, it is linearised to be used as model parame-
ters for the linear elements in other MB models (Huynh et al.
2010; Monteiro 2009). So far, model parameters differ, as
experimental results cover a wider range.
Instead, a recently developed IVD model was used in our
MB model and implemented in demoa. It captures the nonlin-
ear and coupled mechanical response of IVDs in the lumbar
region from pelvis to vertebra L1 (Karajan et al. 2013). In
particular, a FE model of the IVD (Karajan 2012) was used to
pre-compute the mechanical behaviour of the IVD in terms of
stresses and strains. The FE model of the IVD is based on the
theory of porous media. It is capable of capturing the porous
microstructure of the IVD. The mechanical response of the
IVD due to several applied deformation states was captured at
its centre of gravity by homogenisation via an integration of
the resulting stresses at the connecting surface of the adjacent
vertebra. Thus, each of the homogenised results represents
a reaction force and moment due to an applied deformation
state (combination of displacement and rotation). A parame-
terisation using a cubic polynomial turned out to deliver the
best fit of the resulting forces and moments gathered at the
varying deformation states, i. e. sampling points, which can
be related to the displacements and rotations of the MB sys-
tem defined in demoa. For more detailed information on the
representation, the reader is referred to Karajan et al. (2013).
Appendix 5: Hill-type muscles in MB models
In forward dynamics MB models, muscles are often mod-
elled as Hill-type MTCs (Haeufle et al. 2014). This labelling
refers to A.V. Hillss experimental finding (Hill 1938) that
the forcevelocity relation of a muscles fibre is a hyper-
bola. Thus, Hill-type models are phenomenologically based
macroscopic lumped parameter models. Such a model usu-
ally consists of a contractile element (CE), a serial, and a par-
allel elastic element. The corresponding contraction (Eq. 71 ,
CE length lCE ), and activation dynamics (Eq. 72 , activity q
with 0 q 1) of a muscle are described by first-order
differential equations:
lCE = fl (lCE , lMTC , q),
q = f q (q, STIM) (7)
with lMTC : length of MTC, STIM stimulation input. STIM
is calculated by our simple lambda-control model, a bio-
inspired motor control model. It represents the electrical
stimulation signal (summed transmembrane potential) on the
muscles surface and can be compared with surface elec-
tromyography (sEMG). Gnther et al. (2007) included an

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 T. K. Rupp et al.

additional damping component parallel to the serial elastic for a detailed description of the muscle model. It was imple-
element. Hence, the right-hand side of Eq. (7)1 also depends mented in demoa and used for all MTCs in the presented full
on lMTC . By using this modified Hill-type muscle model, human MB model.
movement control is expected to be more feasible, because
eigenoscillations are damped due to the interaction of muscle Appendix 6: Muscle parameters
and segment inertia (Gnther et al. 2007). We refer to Gn-
ther et al. (2007), Haeufle et al. (2014), Mrl et al. (2012) See Table 6.

Table 6 Muscle modelling parameters: maximum isometric force of the contractile element Fmax , optimal fibre length lCE,opt , and serial elastic
element lSEE,0
Muscle Name of fascicle Fmax (N) m ratio lSEE,0 (m) lCE,opt (m)

Multifidus [C] [R]

Laminar fibres MF_m1.laminar 9.00 0.681 0.017954 0.038329
MF_m2.laminar 10.00 0.681 0.015977 0.034108
MF_m3.laminar 11.00 0.681 0.016264 0.034721
MF_m4.laminar 8.00 0.681 0.017277 0.036884
MF_m5.laminar 17.00 0.681 0.013536 0.028897
Single fascicles MF_m1s 18.00 0.661 0.028638 0.055839
MF_m2s 18.00 0.677 0.024826 0.052035
MF_m3s 25.00 0.661 0.028090 0.054771
MF_m4s 21.00 0.562 0.032217 0.041338
MF_m5s 10.00 0.562 0.018348 0.023542
Multi fascicles MF_m1t.1 19.00 0.730 0.030473 0.082389
MF_m1t.2 17.00 0.730 0.039516 0.106839
MF_m1t.3 28.00 0.730 0.049693 0.134355
MF_m2t.1 18.00 0.727 0.029825 0.079423
MF_m2t.2 23.00 0.727 0.040548 0.107979
MF_m2t.3 23.00 0.727 0.042400 0.112911
MF_m3t.1 24.00 0.709 0.049223 0.119927
MF_m3t.2 24.00 0.709 0.047770 0.116389
MF_m3t.3 24.00 0.709 0.046875 0.114207
MF_m4t.1 21.00 0.667 0.028528 0.057141
MF_m4t.2 21.00 0.667 0.039598 0.079316
MF_m4t.3 21.00 0.667 0.051079 0.102311
MF_m5t.1 10.00 0.667 0.042376 0.084879
MF_m5t.2 10.00 0.667 0.029770 0.059629
MF_m5t.3 10.00 0.667 0.017582 0.035218
Erector spinae [C] [C], [De], [M]
Iliocostalis lumborum pars lumborum IL_L1 50.00 0.274 0.136660 0.051577
IL_L2 71.00 0.274 0.111749 0.042175
IL_L3 84.00 0.274 0.088155 0.033271
IL_L4 87.00 0.274 0.061923 0.023370
Longissimus thoracis pars lumborum LTpL_L1 36.00 0.419 0.108408 0.078180
LTpL_L2 42.00 0.433 0.088451 0.067547
LTpL_L3 47.00 0.436 0.069353 0.053613
LTpL_L4 51.00 0.438 0.051840 0.040402
LTpL_L5 53.00 1.000 0.000002 0.065870

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A forward dynamics simulation of human lumbar spine flexion

Table 6 continued
Muscle Name of Fascicle Fmax (N) m ratio lSEE,0 (m) lCE,opt (m)

Intertransversarii mediales [Da] est.

IT_m1 42.84 0.500 0.013848 0.013848
IT_m2 42.84 0.500 0.014834 0.014834
IT_m3 42.84 0.500 0.011768 0.011768
IT_m4 42.84 0.500 0.011933 0.011933
Rectus Abdominis [C] [De]
RA 261.00 0.788 0.076703 0.285103
External Oblique [C] [C]
EO1 90.00 0.389 0.068556 0.043647
EO2 107.00 0.410 0.070880 0.049256
EO3 112.00 0.455 0.061347 0.051216
EO4 108.00 0.470 0.063216 0.056060
EO5 126.00 0.480 0.057528 0.053103
EO6 183.00 0.500 0.046370 0.046370
Internal Oblique [C] [C]
IO1 85.00 0.400 0.077525 0.051683
IO2 103.00 0.400 0.081398 0.054265
IO3 104.00 0.400 0.102389 0.068259
IO4 123.00 0.600 0.072381 0.108572
IO5 108.00 0.600 0.055813 0.083719
IO6 95.00 0.600 0.050050 0.075075
Psoas [C] [C]
Ps_L1_VB 97.00 0.800 0.054573 0.218293
Ps_L1_TP 28.00 0.800 0.054338 0.217352
Ps_L2_TP 97.00 0.800 0.048180 0.192718
Ps_L3_TP 46.00 0.800 0.041697 0.166789
Ps_L4_TP 74.00 0.800 0.036397 0.145589
Ps_L5_TP 80.00 0.800 0.031366 0.125463
Ps_L5_VB 88.00 0.800 0.027617 0.110468
Ps_L1_L2_IVD 55.00 0.800 0.051320 0.205279
Ps_L2_L3_IVD 55.00 0.800 0.044123 0.176491
Ps_L3_L4_IVD 17.00 0.800 0.037173 0.148691
Ps_L4_L5_IVD 36.00 0.800 0.030597 0.122387
All other input parameter values can be set to generic values in a first approximation as in Mrl et al. (2012), which mainly refers to Gnther
et al. (2007). Fmax and the ratio of the muscle fibre length to the MTC length m ratio = lCE /lMTC were adopted from the literature and thus
lCE,0 = m ratio lMTC,init . In turn, lMTC,init was adapted from the spine models geometry in the first time step of the simulation. For all muscles, it
was assumed that lCE,0 = lCE,opt and lSEE,0 = lMTC,init lCE,0 . The source of data is given at the top of each column: [C] Christophy et al. (2011),
[Da] Daggfeldt and Thorstensson (2003), [De] Delp et al. (2001), [M] Macintosh and Bogduk (1987), [R] Rosatelli et al. (2008). est. indicates that
these data were not given explicitly, but were estimated graphically

Appendix 7: Comparison with the literature data
Kinematic data from the literature cannot be compared
directly with results from experimental studies because
investigated overall movements differ. Some studies present
flexionextension results in a combined way, others present
data, measured with less or more flexion amplitudes. There-
fore, relative changes and the order of magnitude were
used for comparison. In the following, vertical transla-
tional and angular displacements, and IVD forces of the
presented lumbar spine model are compared with the lit-
erature data. Additionally, the resultant IVD forces of the
nonlinear intervertebral disc model included into the spine
model are compared with results of three lumbar spine
model variations including the classical, linear interverte-
bral disc model for three different parameter sets. The resul-

123
 T. K. Rupp et al.

A 0 3
our simulation
Hayes et al. (1989)
L4/5
vert. displacement in IVD r z [103 m]
Li et al. (2009)

range of vert. displacement in IVD [mm]

L3/4
0.1 L2/3 2.5
L1/2
0.2
2

0.3
1.5

0.4
1
0.5
0.5
0.6
0 2 4 6 8 10 12 14 16 18
0
L[ ] L1/2 L2/3 L3/4 L4/5

B 5 Fig. 12 Vertical displacements in the lumbar joints, w.r.t local joint

L4/5 coordinate system, increase from cranial to caudal. In vitro studies
ang. displacement in IVD y [ ]

4.5 L3/4
L2/3
4 order; however, they measured flexionextension movements of higher
L1/2
3.5
3
2.5
2
1.5
1
0.5
0
0 2 4 6 8 10
L[ ]
Fig. 11 A Vertical displacements in the local sagittal plane (along the
local longitudinal axis (z: caudocranial direction)) of the subjacent body
and B angular displacements of intervertebral discs y in the local sagit-
tal plane of the subjacent body (its local xz-plane) as a function of the
negative lumbar lordosis angle. Vertical and rotational displacements
are depicted relative to displacement at tSET , i.e. rz,tSET = 0 m and
y,tSET = 0 . Bold lines are used to emphasise translational and rota-
tional displacements in L4/5
tant IVD forces again are compared with the literature data
(Fig. 11).
Vertical displacements in the IVDs increase from cranial
to caudal (top to bottom, see Fig. 12). For a simple flexion
movement simulated with our full human body model, the
displacement amplitudes increase from 0.34 mm (L1/2), to
0.45 mm (L2/3), to 0.58 mm (L3/4), to 0.62 mm (L4/5). In
vitro studies by Hayes et al. (1989) report displacements for
a complete flexionextension movement in the same order:
L1/2 (1.9 mm) L2/3 (2.4 mm) L3/4 (2.5 mm) L4/5
(3.0 mm). The same way, Li et al. (2009) report displacements
for a flexionextension movement in the order: L2/3 (0.2
0.2 mm) L3/4 (0.6 0.4 mm) L4/5 (0.7 0.6 mm).
Additionally, the order of magnitude of all three studies lies
in the same range.
More experimental data exist for the comparison of angu-
lar displacements in the IVDs. Ibarz et al. (2013), White
(Hayes et al. 1989; Li et al. 2009) report displacements in the same
amplitudes. Additional lines depict trend of values
and Panjabi (1990) present various in vivo measurements
of angular joint motion during flexionextension movement.
Interestingly, data presented in the literature do not match,
i.e. some present increasing angular motion from cranial to
caudal (Hayes et al. 1989; Ibarz et al. 2013; Pearcy and
Portek 1984; White and Panjabi 1990) while others present
12 14 16 18 the opposite (Lee et al. 2002; Li et al. 2009; Wong et al.
2004, 2006). The simulation results that were presented in
this study showed an increase in angular displacement during
flexion in the order L1/2 (2.6 ) L2/3 (3.6 ) L3/4 (4.4 )
L4/5 (4.6 ). This caudocranial increase in angular IVD
joint motion is in accordance with flexionextension studies
by Hayes et al. (1989), Ibarz et al. (2013), Pearcy and Portek
(1984), White and Panjabi (1990): L1/2 (5 16 ) L2/3
(7.8 18 ) L3/4 (6 17 ) L4/5 (9 21 ). Again, only
relative changes could be presented (see Fig. 13).
Additionally, we compared our angular displacements
with the intervertebral flexionextension (IVFE) presented
by Lee et al. (2002), Wong et al. (2004, 2006). It indicates
the relationship between net lumbar motion and motion of the
individual vertebrae. The IVFE is often used as input data for
modelling of the IVD element in inverse dynamic models, cf.
slope k in Christophy et al. (2011). Our presented joint kine-
matics plotted against the lumbar lordosis angle are equiv-
alent to the IVFE. Our simulation results for the IVFE also
show a linear-like pattern, like experiments determining the
IVFE characteristics. However, simulated IVFE in all joints
of our model increase caudocranial, whereas in experiments
IVFE slopes increase with investigated joints moving cranial.
This is due to the fact that so far the new IVD model (Kara-
jan et al. 2013) was used for all lumbar IVDs with the same
parameters. The new, nonlinear IVD model was developed
for the L4/5 intervertebral disc and then applied to all other
IVDs. We argue that by applying different scaled material

123
A forward dynamics simulation of human lumbar spine flexion
25
Pearcy et al. (1984)
Hayes et al. (1989)
Ibarz et al. (2013)
range of ang. displacement in IVD []
White & Panjabi (1990)
20 our simulation
15
10
5
0
L1/2 L2/3
Fig. 13 Angular displacements in the lumbar joints, w.r.t local joint
coordinate system, increase from cranial to caudal. In vitro studies
(Hayes et al. 1989; Ibarz et al. 2013; Pearcy and Portek 1984; White
and Panjabi 1990) report displacements in the same order; however, they
measured flexionextension movements of higher amplitudes. Note, we
did not include studies (Lee et al. 2002; Li et al. 2009; Wong et al. 2004,
2006) with the opposite trend in this figure. Additional lines depict trend
of values
properties and an enhanced IVD elements geometry, a more
realistic IVFE pattern would occur. Additionally, it will fur-
thermore result in a more physiological angular displacement
behaviour. An enhanced nonlinear IVD model accounting for
the mentioned shortcomings is already available, but was not
ready to be included in this study yet (Karajan et al. 2014).
In vivo measurements of lumbar joint dynamics are rare.
For a first validation, we used intradiscal pressure measure-
ment data of the IVD L4/5. Measurements were taken with
one healthy male test subject in different postures by Wilke
et al. (1999, 2001). They measured a disc pressure of 0.43
0.5 MPa during relaxed standing of the test subject (body
mass 70 kg, body height 1.74 m). In a 36 flexed standing pos-
ture, the disc pressure increased almost linearly to 1.08 MPa.
The flexion angle was defined differently, i.e. between the
thoracolumbar junction and the sacrum (fl,S1T12 ). The
disc area, measured using magnetic resonance imaging, was
18 cm2 . Thus, the respective axial joint force was 774900 N
in relaxed standing and 1,944 N in a flexed position. In our
model, axial forces increased from Fz,upright = 942 N dur-
ing upright stance to Fz,flex = 1,681 N at tsim,end-nl with
fl,S1T12 = 3 and fl,S1T12 = 33 , respectively. Taking
into account our slightly different flexion angle (higher at the
beginning, smaller at the end), simulated longitudinal forces
using the nonlinear IVD model in L4/5 show good agreement
with experimental data.
In comparison with in vivo measurements of joint dynam-
ics (Wilke et al. 1999, 2001), our new, nonlinear IVD model
included in the spine model shows the best agreement (see
3.1). The classical, linear IVD model variations using either
Monteiro parameters or GardnerMorse parametres result in
higher forces while standing and lower forces when reach-
ing a flexed position. Restoring forces during stance in the
Huynh model show good agreement with our model results,
while forces in flexion are underestimated.
Appendix 8: A simulation of heel impact with the
ground
We simulated a double heel contact of the model with the
ground after a free fall of about 8 mm, i.e. after about 0.04 s,
starting from a completely symmetrical initial position. To
L3/4 L4/5
insure ball contacts would not interfere with the impact, the
ankle joints were fixed in a slightly dorsally flexed orientation
as bracket joints, the latter being a method to set the number
of degrees of freedom in a joint to zero. Just alike, we fixed
the upper body to L1, resulting in a lumped L1-plus upper
body. Due to the stiffness 4 105 N/m of the linear elastic
spring modelling the normal ground reaction force compo-
nent of each heel contact element, both heel elements were
deformed about 2 mm in vertical direction during the impact.
The elements vertical damping force was modelled in pro-
portion to the product of vertical deformation and velocity,
with the corresponding coefficient of proportionality set to
4105 Ns/m2 . Correspondingly, the net vertical ground reac-
tion force reached a peak of about 65 m/s2 (Fig. 14).
The mass distribution in the model was chosen such that
all segment masses represented just the bony parts. This is
because it is only the skeleton that is decelerated during this
impact period of about 20.0 ms (Denoth et al. 1985; Nigg and
Denoth 1980), whereas all soft tissue material like the mus-
cles is coupled viscoelastically to the bones (Denoth 1985;
Gruber et al. 1998; Gnther et al. 2003; Schmitt and Gn-
ther 2011) and decelerated with a time delay. In modelling
its mechanical response, the soft tissue material is denoted
wobbling mass (Denoth 1985). The ratio of wobbling to
segment mass was set to zero in the feet, to 1/2 in the shanks,
and to 2/3 in the thighs (Gnther et al. 2003; Schmitt and
Gnther 2011). For the pelvis bony part, we assumed 3.0 kg,
neglecting an assumed wobbling mass portion of 5.3 kg. The
bony masses of the 24 vertebrae were assumed to decrease
from about 50 g in L5 to 10 g in C1. In our model, the inertia of
all vertebrae from T12 up to C1 is included in the upper body.
For the upper body, we applied the effective mass concept
introduced by Denoth (1986), Denoth et al. (1985): during
the 20.0 ms impact period, the effectively decelerated mass
may depend on both net bony mass of the body and the ini-
tial joint angular configuration. We estimated that one-third
of the 36.8 kg act effectively during impact. Altogether, the
decelerated body masses summed to 25.0 kg in our impact
model.
The resulting distribution of vertical acceleration compo-
nents measured in the global reference frame is plotted in
123

120
100
body acceleration [m/s 2 ]
80
60
40
20
0
20
40
0.04 0.045 0.05 0.055
time [s]
Fig. 14 Vertical components of the models net ground reaction force
and each segments centre of mass acceleration during an impact of the
upright model on the heels from 8 mm falling height
Fig. 14. There is a shock wave propagating from the feet to
the head. The acceleration amplitudes decrease from distal to
proximal in the legs, with a slight deviation from this rule: the
foot acceleration is a little lower than the shank acceleration.
This fact is due to the foot centre of mass being located about
10 cm anterior to the ankle and its upward movement deter-
mined by a superposition of heel translation and footshank
rotation. Above the pelvis, the amplitudes decrease along the
lumbar spine from caudal to cranial. Quantitatively, the accel-
eration maxima are time-shifted according to the following
segmental sequence: shank(s) (0.06 ms), thigh(s) (0.02 ms),
pelvis (0.01 ms) L5 (0.08 ms) L4 (0.26 ms) L3 (0.18 ms),
whole body (0.22 ms) L2 (8.73 ms) L1-plus upper body. The
L1-plus upper body mass is the highest of all segments and
located most distantly from the ground. Its maximum acceler-
ation occurs clearly later than in any other segment including
the whole body.
These numbers can be compared to known experimental
data of shock wave propagation from the ankle to the head
(Lafortune et al. 1996). For this distance, these authors found
propagation times between 5.9 and 4.7 ms, for knee angles
between full extension and 40 flexion, respectively. Our
simulation results demonstrate that the propagation along
the chain of the four distal bodies connected by hard joint
constraints (foot, shank, thigh, pelvis) is faster than the prop-
agation via viscoelastically deforming soft constraints (like
IVDs in our case). Therefore, we would expect that sum-
ming up the time shifts of the 24 IVDs will dominate the
shock wave propagation time from heel to head, because
physiologically there are only four additional distal cartilage
connections from heel to pelvis: lower and upper ankle joints,
knee, and hip. To estimate the propagation velocity depend-
ing on IVD properties, we first calculate the mean time shift
per IVD for the four IVDs located between pelvis and L2
as 0.01+0.08+0.26+0.40
4
ms = 0.73 ms . For the propagation
4 32(7):727731
123
T. K. Rupp et al.
shank time along the vertebral column comprising 24 IVDs, we
foot
thigh
found 24 0.734ms 4.4 ms. The deviation from the data
pelvis by Lafortune et al. (1996) can be easily explained by two
L5 delaying contributions missing in our model so far: (1) those
L4
by the cartilage in the leg joints and (2) those by acoustic
grf
L3 wave propagation in the bones. However, the latter effects
L2
L1 should be negligible because the elastic modulus of bones is
about 4 orders of magnitude higher than that of IVDs, with
approximately the same mass density.
The distance between L5 and C1 is roughly 60 cm. Thus,
we can estimate the propagation velocity from our computer
experiment to be clong = 60 cm/4.4 ms = 136 m/s. Based
0.06 0.065 0.07
on theory, we may predict this number based on elastic mod-
ulus E = = Fl Al00 with the stress = A0F , the strain
= l0l , and the stiffness K = Fl . The area of a verte-
bras upper endplate is roughly 1 cm2 and the range of IVD
thicknesses is about 1 cm. . .0.5 cm from L5 to C1. In gen-
eral, wave propagation velocity clong in solids depends also
on the Poisson ratio = A0A / l0l . For longitudinal waves,

E(1)
theory predicts clong = (1 2 ) , where symbolises
the mass density. With a lumbar IVD stiffness estimation of
5 105 N/m (compare Table 2), lumbar thickness of 1 cm,
and a small Poisson ratio 0.5, a value of clong = 73 m/s
can be predicted from theory. This is nearby the theoretical
minimum value for = 0. This theoretical clong increases
for approaching the pole 0.5. For = 0.45, clong would
be about twice the minimum value.
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