Analysis of isometric cervical strength with a nonlinear ... ?· Analysis of isometric cervical strength…
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Multibody Syst Dyn (2016) 36:339362DOI 10.1007/s11044-015-9461-z
Analysis of isometric cervical strength with a nonlinearmusculoskeletal model with 48 degrees of freedom
E. de Bruijn1 F.C.T. van der Helm1 R. Happee1
Received: 15 May 2014 / Accepted: 8 May 2015 / Published online: 2 June 2015 The Author(s) 2015. This article is published with open access at Springerlink.com
Abstract Background: Musculoskeletal models served to analyze headneck motion andinjury during automotive impact. Although muscle activation is known to affect the kine-matic response, a model with properly validated muscle contributions does not exist to date.The goal of this study was to enhance a musculoskeletal neck model and to validate passiveproperties, muscle moment arms, maximum isometric strength, and muscle activity.
Methods: A dynamic nonlinear musculoskeletal model of the cervical spine with 48 de-grees of freedom was extended with 129 bilateral muscle segments. The stiffness of thepassive ligamentous spine was validated in flexion/extension, lateral bending, and axial ro-tation. Instantaneous joint centers of rotation were validated in flexion/extension, and mus-cle moment arms were validated in flexion/extension and lateral bending. A linearized staticmodel was derived to predict isometric strength and muscle activation in horizontal headforce and axial rotation tasks.
Results: The ligamentous spine stiffness, instantaneous joint centers of rotation, musclemoment arms, cervical isometric strength, and muscle activation patterns were in generalagreement with biomechanical data. Taking into account equilibrium of all neck joints, iso-metric strength was strongly reduced in flexion (46 %) and axial rotation (81 %) comparedto a simplified solution only considering equilibrium around T1C7, while effects weremarginal in extension (3 %).
Conclusions: For the first time, isometric strength and muscle activation patterns wereaccurately predicted using a neck model with full joint motion freedom. This study demon-strates that model strength will be overestimated particularly in flexion and axial rotation ifonly muscular moment generation at T1C7 is taken into account and equilibrium in otherneck joints is disregarded.
Keywords Musculoskeletal Neck Cervical Model Isometric Validation Loadsharing Muscle
B R. HappeeR.Happee@TUDelft.nl
1 Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft,The Netherlands
340 E. de Bruijn et al.
AbbreviationsHUMOS Human Model for Safety projectPMHS Post Mortem Human SubjectPCSA Physical Cross-Sectional AreaICR Instantaneous Joint Center of RotationT1 First thoracic vertebraC0 SkullC1C7 First to seventh cervical vertebraeMVC Maximum Voluntary ContractionDOF Degrees-of-freedomEMG Electromyography
The complex anatomy of the human neck allows for high flexibility in rotation and trans-lation through seven cervical vertebrae controlled by over 70 muscles. This high level ofcomplexity has made it difficult for scientists to understand load distributions occurring inthe cervical spine. Although in vitro research has made properties available related to theanatomy and passive loading of the neck, it has proven difficult to obtain in vivo data ofthe deep cervical tissues from experiments. Computer models have been successful at com-bining anatomical knowledge with volunteer data to estimate internal loads acting on thecervical system. Available biomechanical head and neck models vary widely in complex-ity. Simple models using one or two pivots (inverted pendulum models) are helpful to gaininsight into the overall dynamics of the head and neck system , but to mimic internaltissue deformation  detailed three-dimensional models become necessary.
Detailed models with passive musculature have been used extensively to evaluate injuryrisks during high impact loading . Recently developed automotive systems in activesafety [14, 15] and driving comfort  involve the occupant response to (autonomous)braking and evasive maneuvers prior to crash, which has pushed the demand towards sim-ulations with active muscles. This requires proper validation of the modeled muscular re-sponses in pre-crash conditions, as well as during impact. In several active neck models thejoint centers of rotation are fixed , even though intervertebral motion can only befully captured when both joint translations and rotations are possible [4, 22, 23]. The place-ment of fixed joint locations greatly influences the models behavior, particularly because ofits effect on muscle moment arms [17, 18]. To model intervertebral motion correctly jointsshould ideally have full freedom of motion in rotation, shear, and compression/elongation.Of the active neck models with sufficient detail to accurately model tissue dynamics betweenvertebral joints [4, 7, 11, 13, 2428], none have provided a validation of muscle activationpatterns in isometric conditions. It is important to evaluate the models isometric responsefirst to properly assess cervical muscle strength in different loading directions, and secondlyto verify the directional activity of the muscles. In a number of models, isometric valida-tion is performed by evaluating moments at the lowest joint (T1C7) while equilibrium atother joints is disregarded [17, 18]. For proper isometric validation, the equilibrium of theentire spine should be taken into account when evaluating cervical strength and muscularresponses.
Our objectives were (1) to enhance a dynamic nonlinear musculoskeletal neck modelwith 48 degrees of freedom [9, 29], (2) to validate passive properties and muscle momentarms, and (3) to validate isometric strength and muscular activity of healthy volunteers,taking into account the equilibrium of all vertebral joints.
Analysis of isometric cervical strength with a nonlinear musculoskeletal model 341
Fig. 1 Lateral (sliced) andanterior view of the nonlineardynamic model depictingmuscles, vertebral geometry, andskull. Joint centers of rotation ofthe linear static model areillustrated by green balls
Table 1 Intervertebral disc stiffness and damping used in the model at each joint except for C2C1 andC1C0. Disc stiffness was obtained from cadaveric segments tests. Damping was adjusted manually to im-prove the models response during impact loading
Anterior shear 62  1000 [9, 29]
Posterior shear 50  1000 [9, 29]
Lateral shear 73  1000 [9, 29]
Tension 68  1000 [9, 29]
Compression 8222931 nonlinear [9, 36] 1000 [9, 29]
Stiffnessup to 1 N m
Stiffnessexceeding 1 N m[N m/rad]
Damping[N m s/rad]
Flexion-extension Nonlinear  (see text) 1.5 [9, 29]
Lateral bending Nonlinear  (see text) 18.91  1.5 [9, 29]
Axial rotation Nonlinear  (see text) 24.06  1.5 [9, 29]
A dynamic nonlinear neck model (Fig. 1), previously validated for automotive impact[9, 11, 29, 30], was extensively revised and validated using biomechanical data summarizedin Tables 1, 2, 3. The model contains nonlinear intervertebral disc compliance in rotation andtranslation, ligaments and facet joint contact dynamics, and was extended with 34 musclepairs (129 bilateral segments) with discrete lines of action using via points.
The dynamic nonlinear neck model was written in the graphics-based simulation softwareMADYMO 7.5  and was called by Matlab R2012b (Matlab/Simulink, The MathworksInc., Natick, USA) through Simulink to control muscle actuation. A time step of 2 105 s
342 E. de Bruijn et al.
Table 2 Model parameters for active and passive muscle behavior (largely adapted from van der Horst )
Muscle parameter Symbol Unit Value Reference
Length of muscle at initial position l0 m Derived from the model
Optimum length of muscle lopt m 1.05l0 [9, 52]
Maximum shortening velocity of muscle vmax m 6lopt 
Maximal isometric stress max N/cm2 70 
Shape forcevelocity curve (shortening) CEsh 0.25 [74, 75]
Shape forcevelocity curve (lengthening) CEshl 0.075 [38, 75]
Maximum relative force (lengthening) CEml 1.5 
Shape active forcelength curve Sk 0.54 
Passive forcelength stiffness k N/cm2 3.34 [29, 51]
Passive forcelength asymptote a 0.7 
Table 3 Biomechanical sources for modeling and verification (see also Tables 1 and 2)
Components nonlinear model Modelparameters
Skeletal geometry & inertia [29, 33]
Ligament insertions and origins  Figs. 35: Passive spine stiffness incl.ligaments Table 3: ICR estimates [57, 58]
Ligament nonlinear forcestrain curves [29, 39, 40]
Ligament slack (tuned)
Muscle geometry  Table 4: Muscle moment arms Table 5 & Fig. 6: MVC [6166, 68, 77]Fig. 7: Muscle function 
Muscle via points 
was applied with a fixed-step 4th order RungeKutta ordinary differential equation solver.Execution time was roughly 240 times real-time on a 2.8 GHz processor.
A static model was derived by linearization of the dynamic model in the neutral posi-tion (Fig. 1). The static model was implemented in Matlab and was used to estimate maxi-mum isometric horizontal head forces and head twist moments. Muscle activations, derivedwith the static model, were subsequently applied to the dynamic model for verification.
2.2 Passive properties
2.2.1 Skeletal geometry
The dynamic model comprised nine rigid bodies; the skull (C0