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Influence of bending pre-load on the tensile response of the lumbar spine

Joseph Avila, John Humm, Klaus Driesslein, David Moorcroft, Frank Pintar

PII: S0021-9290(22)00408-0
DOI: https://doi.org/10.1016/j.jbiomech.2022.111367
Reference: BM 111367

To appear in: Journal of Biomechanics

Received Date: 22 September 2021

Revised Date: 9 October 2022
Accepted Date: 30 October 2022

Please cite this article as: J. Avila, J. Humm, K. Driesslein, D. Moorcroft, F. Pintar, Influence of bending pre-load
on the tensile response of the lumbar spine, Journal of Biomechanics (2022), doi: https://doi.org/10.1016/
j.jbiomech.2022.111367

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 Original Article for the Journal of Biomechanics

Influence of bending pre-load on the tensile response of the lumbar spine

Joseph Avila, PhD1

John Humm, PhD2
Klaus Driesslein, MS2
David Moorcroft, MS3
Frank Pintar, PhD1

1Department of Biomedical Engineering

Medical College of Wisconsin and Marquette University
Milwaukee, WI, USA

2Department of Neurosurgery
Medical College of Wisconsin
Milwaukee, WI, USA

3Civil
Aerospace Medical Institute
Federal Aviation Administration
Oklahoma City, OK, USA

Number of words from Introduction through Discussion: 3526

Number words in abstract: 233
Number of figures: 9

Correspondence:
Frank Pintar, PhD
Kern Professor and Chair
Joint Department of Biomedical Engineering
8701 Watertown Plank Road
Medical College of Wisconsin and Marquette University
Milwaukee, WI 53226
fpintar@mcw.edu
(414) 384-2000 x41534

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 Original Article for the Journal of Biomechanics

ABSTRACT (NUMBER WORDS: 233, LIMIT 250)

Previous full body cadaver testing has shown that both obliquely oriented seats in survivable aircraft

crashes and far-side oblique crashes in vehicles present distinctive occupant kinematics that are not yet

well understood. Knowledge surrounding how these loading scenarios affect the lumbar spine is

particularly lacking as there exists minimal research concerning oblique loading. The current study was

created to evaluate a novel experimental method through comparison with existing literature, and to

examine the impact of a static bending pre-load (posture) on the load-displacement response for the

whole lumbar spine loaded in non-destructive axial distraction. T12-S1 lumbar spines were tested in

tension to 4 mm of displacement while positioned in one of three pre-load postures. These postures were:

the spine’s natural, unloaded curvature (neutral), flexed forward (flexed), and combined flexion and

lateral bending (oblique). Deviations from a neutral spine position were shown to significantly increase

peak loads and tensile stiffness. The presence of a flexion pre-load caused statistically significant increases

in tensile stiffness, tensile force, and bending moments. The addition of a lateral bending pre-load to an

already flexed spine did not significantly alter the tensile response. However, the flexion moment

response was significantly affected by the additional postural pre-load. This work indicates that the initial

conditions of distraction loading significantly affect lumbar spine load response. Therefore, future testing

that seeks to emulate crash dynamics of obliquely seated occupants must account for multi-axis loading.

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 Original Article for the Journal of Biomechanics

INTRODUCTION

In recent years, oblique impacts and their effects on occupant safety have been an area of expanding

research. Far-side oblique collisions have been shown to produce unique occupant kinematics and a high

incidence of severe injuries in the automotive environment (Forman et al., 2013; Gabler et al., 2005;

Humm et al., 2018). In the aviation environment, the increased use of obliquely mounted seats prompted

research aimed at investigating gross occupant kinematics for crash level loading in such a seating

orientation (Humm et al., 2015) (Figure 1). As oblique aircraft seating is still a novel configuration, it is not

known whether these obliquely mounted seats offer occupants the same level of protection as traditional

airline seats under existing aviation safety standards.

Previous full body Postmortem Human Subject (PMHS) tests were conducted to investigate gross

occupant kinematics in an oblique seating posture using the prescribed aircraft emergency landing test

conditions (Code of Federal Regulations, 1988; J. Humm et al., 2015). From this testing, severe lumbar

spine injuries were produced at the L5/S1 junction through a combination of multi-axis bending and

distraction. An examination of the literature demonstrates a distinct lack of knowledge surrounding this

oblique loading paradigm. Much of the whole lumbar spine experimental work that does exist is focused

on single bending ranges of motion and motion coupling, with limited studies involving axial loading

(tension or compression). Even fewer have examined the effects of combined loading, particularly

combined bending and axial loads (Stemper et al., 2018).

A review of the literature revealed very little published information on the response of the lumbar spine

to axial distraction. Demetropoulos et al. (1998) tested whole-column lumbar spine specimens and the

Hybrid III lumbar spine to sub-failure displacements in compression, tension, flexion, extension, lateral

bending, anterior shear, posterior shear, and lateral shear. This work detailed peak tensile load and linear

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 Original Article for the Journal of Biomechanics

tensile stiffness values for the whole lumbar spine, but testing was conducted with spines in their natural,

unstressed position.

The effect posture has on the lumbar spine’s response to loading has also seldom been evaluated. Spinal

posture has been shown to affect the load path and transmission of the forces through the column as well

as the intersegmental and overall kinematics (Hedman and Fernie, 1997; Panjabi et al., 1989). Work from

Panjabi et al. (1989) examined the effects of combined bending on motion coupling in the whole lumbar

spine. While Panjabi was specifically examining the impact of a flexed or extended posture on motion

coupling, valuable information was gained about the impact on combined bending ranges of motion. In

lateral bending, most non-neutral postures produced only a slight decrease in the total range of motion

(ROM) of the lumbar spine which was the result of compensatory reactions. However, in the fully flexed

posture a large decrease was observed in lateral bending ROM at the L5/S1 joint. (Panjabi et al., 1989).

Lumbar spine research that combines multi-axis (oblique) bending with axial distraction has yet to be

detailed. Changes to future automotive and aircraft interiors where the occupants may be seated at

oblique angles to the centerline of the vehicle may lead to complex bending and distraction of the lumbar

spine. Research to delineate the biomechanics of this loading scenario is necessary for the advancement

of occupant safety. Particularly, understanding is needed regarding how this type of loading affects the

load response at the L5/S1 joint. To simplify the loading scenario of multi-axis bending and distraction, an

experimental setup was achieved that produced a static representation of the end range of bending along

with non-static tensile loading. In order to understand how different seating orientations affect the

potential for injury, proposed experimental conditions must first be evaluated. The current study was

created to evaluate a novel experimental method and its ability to produce a non-destructive lumbar spine

load response in line with existing literature. This was achieved through comparison of results detailing

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 Original Article for the Journal of Biomechanics

the load response of the lumbar spine subjected to non-destructive multi-axis bending and distraction to

comparable literature. An additional objective of the current work was to evaluate the impact of a static

bending pre-load (posture) on the load-displacement response for the whole lumbar spine loaded in non-

destructive axial distraction.

METHODS

Specimen Preparation

15 spines (male n=13, female n=2) excised from unembalmed, fresh-frozen human cadaver subjects were

tested. Specimens were pre-screened for blood-borne pathogens and were examined radiographically to

assess the integrity of bony and soft tissue structures. Spines with collapsed disc spaces or bridging

osteophyte growths were excluded. The study protocol obtained IRB approval and was approved by the

Research and Development Committee and all relevant subcommittees at the Zablocki Veterans Affairs

Medical Center in Milwaukee, WI. The average (SD) age, stature, and mass of the subjects were 51.4 years

(13.7), 174.5 cm (6.8), and 82.4 kg (31.4).

Spines were isolated from the T12 vertebra through the sacrum. Muscular tissue was removed from

around the spine leaving passive ligamentous structures. Throughout preparation and testing, spines were

kept moist with saline soaked gauze. Both ends of the spines were potted in polymethyl methacrylate

(PMMA) to allow connection to the test fixtures. The superior end of the spine was potted such that the

T12/L1 joint was unrestricted while having the majority of the T12 vertebra encased in PMMA. The inferior

end of the spine was potted similarly, with the L5/S1 joint left unrestricted for all degrees of freedom.

Custom pins were fixed into the vertebral bodies of L1-L5 to allow for attachment of 3 non-collinear

retroreflective motion capture markers. After spines were potted and instrumented, specimens were

taken for a pre-test CT scan to define the relationship of motion tracking markers to anatomic

components.

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 Original Article for the Journal of Biomechanics

Loading and Data Collection System

An electrohydraulic piston (MTS; Eden Prairie, MN) was used to impart a distractive displacement on the

superior potting of the spine. A linear variable differential transformer (LVDT) on the piston measured

total column vertical displacement. Two six-axis load cells (Sunrise Instruments; Canton, MI and MG

Sensor; Rheinmünster, Germany) were used to measure load data at both ends of the spine between the

specimen potting and the superior and inferior test fixtures. A TDAS Pro (DTS; Seal Beach, CA) data

acquisition system was used to collect all data. Piston and load cell data were collected at 20 kHz. 3D

kinematic data were collected using motion capture cameras and software (Vicon; Oxfordshire, UK) at 1

kHz. A digital inclinometer was used to measure the amount of bending in the specimen’s pre-test

posture.

Testing Procedure

Each spine was tested in axial distraction while positioned in one of three separate postures in a pre-

defined order. The postures and order were the spine’s natural, unloaded position (neutral), flexed

(flexed), and flexed and laterally bent 15 degrees (oblique) (Figure 2). A novel positioning table was

designed and assembled to accurately position the spines with the required combination of flexion and

lateral bending in a repeatable way that minimized the axial preload imparted prior to distractive testing

(Humm et al., 2021). The inferior PMMA was rigidly fixed to the novel positioning table while the piston

imparted a vertical displacement on the superior PMMA. The table can induce complex loading scenarios

through motion about six degrees of freedom. While aligned in a given posture, the positioning table was

adjusted to reduce the preload about all axes, with particular focus on minimizing the axial load (< 50 N)

(Table 1).

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 Original Article for the Journal of Biomechanics

After initial superior connection to the piston, the inferior end of the spine was left free for manual

manipulation to establish the subject-specific forward flexion angle. This was conducted by manually

applying a direct posterior-anterior load to the sacral potting in the sagittal plane about the fixed T12,

much like an inverted cantilever beam. The forward flexion position was defined as the subject-specific

flexion angle recorded when an approximately 30 Nm bending moment was measured by the superiorly

mounted load cell during manual manipulation. The use of a pre-defined bending moment allowed each

spine to be positioned near its own physiologic flexion limit. The pre-selected 30 Nm bending moment

was determined to be a safe load limit and within the physiologic limits of the spine (Miller et al., 1986).

Because the positioning device allowed a rotational degree of freedom while translating the x-y cross-

table and could concurrently be adjusted in the z-axis to reduce axial loads while obtaining the prescribed

angle, the final position resulted in minimal off-axis loads. Thus, the measured force and moment

preloads during testing were typically much lower than those seen during manual manipulation due to

the combined adjustments of shear, axial load, and induced bending from the positioning table (Table 1).

This resulted in an average (SD) initial flexion moment calculated at S1 of 6.61 (3.57) Nm. The lateral

bending angle was set at 15 degrees for each specimen. This was determined from previous whole-body

PMHS tests where 15 degrees was the approximate amount of lateral bending of the lumbar spine relative

to the pelvis just prior to failure in tests measuring occupant response in obliquely mounted seats in the

aircraft environment (Humm et al., 2015). Lateral bending of a pre-flexed spine resulted in an initial

average (SD) lateral bending moment of -5.59 (3.94) Nm at the S1 level. A free body diagram detailing

positioning and relevant coordinate systems can be found on Figure 3.

After assessment of the subject specific flexion angle, the table was aligned to the unloaded sacral angle

and fixed to the inferior potting. After the neutral posture tensile test, the table was repositioned for the

flexed posture test, then again for oblique. Spine positioning was achieved through controlled linear table

motions in a single plane, with the sacrum free to rotate in that plane. As an example, to achieve the

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 Original Article for the Journal of Biomechanics

flexed posture the table and sacrum were translated forward and upward as the T12 remained fixed in

position and the sacrum was free to rotate in the sagittal plane. Translation continued until the previously

defined flexion angle was achieved. A more detailed discussion of how table positioning was conducted

can be found in a previous publication (Humm et al 2021). Testing began by preconditioning the spine

with 20 cycles of 3 mm distraction at 1 Hz in the neutral position. After preconditioning, each spine was

run through a sub-failure test of 4 mm distraction at 100 mm/s in each of the three positions. The

distractive displacement of 4 mm was derived from previous full body testing and selected for the minimal

likelihood of disrupting any spine structure. The test speed of 100 mm/s is frequently utilized as a low-

speed impact velocity in spine testing. Multiple preconditioning cycles were conducted at a separate rate

and displacement from test cycles in order to minimize any damaging effects of repeated higher rate

tensile loading. Lateral x-ray images were taken, and load cell data were reviewed for evidence of failure

after each test.

Analysis

Data were processed using custom MATLAB (MathWorks, Natick, MA) scripts and filtered according to

SAE J211 standards (SAE International, 2014). The positions of the markers relative to the local anatomy

were determined from the instrumented CT scans using 3D-Slicer. Points on the superior and inferior

fixations were similarly digitized to obtain the position and orientation of the inferior load cell with regard

to the S1 coordinate system (Fedorov et al., 2012). Details of this process can be found in a previous

publication (Humm et al., 2021). Inferior loadcell values were first transformed to the S1 anatomic

coordinate system using a calculated S1/Load cell rotation matrix. Moment values at the anatomical

location were then calculated using the following equation involving transformed load cell values and

calculated values derived from a cross product:

𝑀𝑆1 = 𝑀𝐿𝐶 + (𝑟𝐿𝐶 ― 𝑆1 × 𝐹𝐿𝐶)

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 Original Article for the Journal of Biomechanics

Where:

𝑀𝑆1 = Calculated anatomical S1 Moment

𝑀𝐿𝐶 = Moment at load cell aligned to S1 anatomic coordinate system

𝑟𝐿𝐶 ― 𝑆1 = Vector from S1 origin to center of load cell

𝐹𝐿𝐶 = Force at load cell aligned to S1 anatomic coordinate system

Statistical analyses were conducted in SPSS (IBM; Armonk, NY) to a confidence level of 𝛼 = 0.05. An initial

power analysis estimated that in order to achieve the standard 80% power (β = 0.2) to detect an expected

peak tensile force difference of 50 N, 14 specimens would need to be tested. This was based on the T

statistic with paired data. The null hypothesis for all metrics was that no difference existed between peak

loads or tensile stiffnesses. Peak tensile force data were found to be normally distributed through the

application of the Shapiro-Wilke test of normality and corroborated with normalized Q-Q plots. Repeated

measures ANOVAs were used to investigate significant differences in tensile stiffness and peak loads

between positions. Post Hoc testing was conducted by way of the Least Significant Difference (LSD)

method with the Bonferroni multiple comparison adjustment. Differences between male and female

specimens were not evaluated.

RESULTS

All results are presented in the S1 anatomic coordinate system whose origin is at the center of the sacral

endplate and is oriented according to the SAE J211 standard coordinate system (Figure 3) (SAE

International, 2014). Due to data acquisition failure, the data from three spines were excluded from the

analysis. Peak loads coincided with peak distractive displacement. Due to the higher test speed and short

piston stroke, not every test reached a total column displacement of 4.0 mm (Figure 4). Peak loads are

reported at a distractive T12 displacement of 3.8 mm relative to the sacrum. Whole lumbar column static

bending stiffnesses were calculated for flexion in the flexed position, and for both flexion and lateral

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 Original Article for the Journal of Biomechanics

bending in the oblique position. Static bending stiffnesses were calculated as the S1 bending moment

corresponding to the amount of T12/S1 bending (both forward and lateral) in the final spine positions

immediately prior to distractive testing. A quasi-static flexion whole column stiffness of 0.27 (0.12)

Nm/deg was found for the flexed position. This stiffness increased to 0.43 (0.23) Nm/deg in the oblique

position. A paired t-test revealed a significant increase (p=0.001) in the quasi-static flexion stiffness with

the addition of the lateral bending moment. With a flexion pre-load, the quasi-static lateral bending

stiffness was found to be 0.39 (0.30) Nm/deg. Whole column tensile stiffness was calculated as the linear

slope of tensile force vs T12 displacement between 0.5 and 3.5 mm of distraction (Figure 4). Average

values for the neutral, flexed, and oblique position tensile stiffnesses were 80.30 (24.00) N/mm, 210.45

(42.90) N/mm, and 223.22 (49.78) N/mm respectively (Figure 5).

Post hoc testing revealed significant differences between both the flexed (p<0.001) and oblique (p<0.001)

position stiffnesses as compared to the neutral stiffness. A significant difference was not detected

between the flexed and oblique stiffnesses (p=0.134). The peak values of tensile force, lateral bending

moment, and flexion moment at 3.8 mm of distraction for the three positions are shown in Table 2 and

Figure 6. Repeated measures ANOVAs were conducted between the three positions for each load type.

Each had a p-value <0.001, indicating significant differences within each load type (Table 3).

DISCUSSION

The previously detailed results describe changes to the lumbar spine response to tensile loading in

different postures. Differences were observed in both peak load as well as whole column bending and

tensile stiffnesses. These results begin to form a better understanding of how complex loading affects the

response of the lumbar spine.

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 Original Article for the Journal of Biomechanics

Whole column, quasi-static bending stiffnesses from previous studies were estimated from the available

intervertebral ROM vs bending moment data based on the concept of superposition for intervertebral

rotational displacements (Baisden et al., 2010; Cook et al., 2015; Guan et al., 2007; Panjabi, 1994; Panjabi

et al., 1989; Soni et al., 1982; Yamamoto et al., 1989). The values presented from available literature are

simply approximations based on graphical analysis in order to produce a metric comparable to the current

work. Quasi-static flexion stiffness of the whole lumbar spine ranged from 0.20-0.31 Nm/deg, with the

current study finding a stiffness of 0.27 Nm/deg (Guan et al., 2007; Panjabi et al., 1994; Soni et al., 1982;

Yamamoto et al., 1989). The estimated lateral bending stiffness in the presence of a pre-flexed posture

was found to be 0.45 Nm/deg, as compared to 0.39 Nm/deg from the current work (Panjabi et al., 1989).

Given the natural variance of biomechanical data, bending stiffnesses found in the current work are not

considered to be different from those of previous studies.

The only appropriate comparison for the tensile load response comes from Demetropoulos et al. (1998).

For their work, whole lumbar spine testing was conducted at 100 mm/s to a predetermined linear

displacement for each individual mode of loading. In tension, spines were tested to 2.54 mm, but the

average peak load was reported at 1.27 mm to coincide with the maximum tensile displacement of the

HIII spine. Demetropoulos (1998) noted a total column tensile stiffness of 79.16 (22.81) N/mm in the

neutral position, which agrees with the stiffness found from the current study of 80.30 (24.00) N/mm.

The tensile stiffnesses found in the two pre-stressed postures offer novel results which demonstrate large

differences as compared to the neutral position. The flexed and oblique postures increased the tensile

stiffness by 162% and 178%, respectively. Peak load values follow a similar pattern with a dramatic

increase in the presence of an initial postural pre-load. The addition of a bending pre-load significantly

increased the peak tensile force from the neutral condition for both the flexed and oblique conditions.

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 Original Article for the Journal of Biomechanics

This increase was primarily produced after the addition of a bending pre-load in the sagittal plane. While

there was a statistically significant increase in the peak tensile force after the addition of a flexion pre-

load, there was a notable although not significant increase after the addition of a lateral bending pre-load.

It cannot be stated whether pure flexion or pure lateral bending produces the greatest change in peak

tensile force or stiffness upon distraction, but this shows that the tensile response of the spine is most

sensitive to an initial deviation from the neutral posture. The initial flexion of the spine increases the

tensile preload of the posterior ligaments. With the addition of lateral bending, tensile forces in the

previously stressed posterior ligaments are likely increased on the convex side of lateral bending while

being decreased on the concave side of lateral bending. The probable result being a minimal change from

the initial bending load.

Unlike peak tensile force, there was a statistically significant change in the peak flexion moment between

all three positions (Figure 6). Similarly, a significant increase in quasi-static flexion stiffness of the spine

with the addition of lateral bending was observed. This result was corroborated by the combined bending

results from Panjabi et al. (1989). Given the postural dependence of lateral bending stiffness found by

Panjabi, it provides evidence that the quasi-static flexion stiffness would also increase in the presence of

lateral bending. A significant change in the lateral bending moment response was demonstrated between

the flexed and oblique conditions. This was an expected result as lateral bending was only intentionally

introduce in the oblique condition.

In addition to the results presented herein; several limitation remain. While it has been shown that spine

degeneration affects numerous properties, particularly stiffness, this was not evaluated for the given

results based on posture being the primary factor. Pooling of different levels of degeneration likely led to

an increase in variance of the results. The load-history dependence of the spine and the uniform order

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 Original Article for the Journal of Biomechanics

with which all spines were tested could have impacted the load response. Differences seen in load

response cannot be fully attributed to changes in bending pre-load because the testing order was not

randomized. Changes seen between conditions could be in part an effect of progressive testing on a single

specimen. However, the particular testing order was chosen to preserve spine structural integrity by

eliminating the need to move spines in and out of various positions while also maximizing their utility. The

unique load distribution (particularly moment distribution) from cranial to caudal introduced by the

selected testing methodology also has the potential to have affected the distraction results. The non-

destructive testing methodology also falls short of identifying differences in the failure response of the

lumbar spine given different postural pre-loads. The quasi-static strain rate and the small amount of

displacement only begin to illuminate the necessary conditions to properly examine the impact of

traumatic oblique loading on the lumbar spine.

While no determinations can be made regarding the failure tolerance of the lumbar spine in oblique

loading based on the current work, important conclusions remain. The novel experimental methodology

presented here produced results in agreement with comparable non-destructive studies, demonstrating

the viability in applying the methodology to failure inducing tests. Moreover, the methodology was shown

to produce differing load responses in the lumbar spine when subjected to distinct postural preloads,

which goes beyond what can be found in the current literature. This work indicates that the initial

conditions of distraction loading significantly affect lumbar spine stiffness. Therefore, future testing that

seeks to emulate crash dynamics of obliquely seated occupants must account for multi-axis loading. This

knowledge will begin to lay the foundation for understanding the more complex dynamic bending and

tension scenario, which will provide critical information on how the spine behaves as new loading patterns

emerge from advances in human travel.

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 Original Article for the Journal of Biomechanics

ACKNOWLEDGMENTS

This research study was supported by resources from the Federal Aviation Administration (Grant FAA-

17G002) and the Department of Veterans Affairs Research Facilities. The opinions, interpretations,

conclusions, and recommendations are those of the authors and are not necessarily endorsed by the

Federal Aviation Administration or other sponsors. The authors would also like to recognize Justine Bales

for her invaluable assistance in data collection.

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FIGURE CAPTIONS

Figure 1: A comparison of the orientation between a traditional, forward-facing seat (A.) with that of an

obliquely mounted seat (B.). The arrow represents the direction of travel for the aircraft.

Figure 2: Instrumented spine in the A) neutral position B) flexed position C) oblique position (combined

flexion and lateral bending) prior to distractive testing.

Figure 3: Free body diagram with relevant coordinate systems and applied loads for each position. Lower

loadcell is positioned and rigidly fixed prior to testing. The upper loadcell is only able to translate along its

z-axis. A) Spine in neutral position B) Spine in flexed position with ≈ 30 Nm of flexion pre-load C) Spine in

oblique position with 15° lateral bending pre-load added to the flexion pre-load.

Figure 4: Tensile force-displacement trace averages for each of the three test postures. The differences in

tensile stiffness and peak loading are readily apparent.

Figure 5: Whole lumbar column (T12-S1) tensile stiffness by posture with error bars representing standard

deviation

Figure 6: A comparison of peak loads between different test postures separated by load type.

Table 1: Average and Standard Deviation Pre-load Values for Flexed and Oblique Postures

Table 2: Mean and Standard Deviation by Load Type and Test Position

Table 3: P-Value for LSD Post Hoc Results Comparing Tensile Stiffness and Peak Loads Between Test

Positions

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A., Paskoff, G., Shender, B. S. 2018. Biomechanical tolerance of whole lumbar spines in straightened
posture subjected to axial acceleration. Journal of Orthopaedic Research 36, 1747–1756.
Yamamoto, I., Panjabi, M. M., Crisco, T., Oxland, T. R. 1989. Three-Dimensional Movements of the Whole
Lumbar Spine and Lumbosacral Joint. Spine 14, 1256–1260.

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Figure 1

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Figure 2

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Figure 3

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Figure 4

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Figure 5

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Figure 6

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Table 1.

Table 1. Average and Standard Deviation Pre-load Values for Flexed and Oblique
Postures
Ant. Lat. Axial Lat.
Flexion Torsion
Shear Shear Load Bending
(Nm) (Nm)
(N) (N) (N) (Nm)
13.25 -7.44 -9.10 0.98 3.03 -0.80
Upper LC (23.75) (16.45) (54.04) (2.57) (6.05) (4.53)
47.86 -16.72 -19.75 -1.95 0.71 -1.54
Flexed Lower LC (30.08) (16.97) (49.63) (2.63) (4.26) (1.01)
56.04 -14.33 -18.84 -0.38 6.61 -1.59
Anat. Load (26.83) (17.23) (45.54) (2.53) (3.57) (1.07)
4.60 -0.59 -26.61 -1.55 1.84 -2.28
Upper LC (21.27) (15.17) (74.75) (3.79) (3.87) (6.43)
25.56 11.39 -19.56 -2.57 7.70 -3.78
Oblique Lower LC (32.47) (27.11) (76.46) (1.84) (8.10) (2.35)
32.52 13.07 -25.44 -5.59 10.66 -4.66
Anat. Load (26.04) (16.98) (72.36) (3.94) (5.48) (3.09)

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Table 2

Table 2. Mean and Standard Deviation by Load Type and Test Position

Load Position Mean Std. Dev.

Neutral 274.86 89.87

Tensile Force (N) Flexed 813.97 184.31

Oblique 873.88 205.23

Neutral 3.32 2.79

Lat. Bending Moment (Nm) Flexed 0.72 4.15

Oblique -15.53 7.62

Neutral -2.32 3.20

Flexion Moment (Nm) Flexed 16.42 6.62

Oblique 20.01 6.92

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Table 3

Table 3. P-Value for LSD Post Hoc Results Comparing Tensile

Stiffness and Peak Loads Between Test Positions

Tensile Tensile Flexion Lat. Bending

Stiffness Force Moment Moment
Flexed Oblique Flexed Oblique Flexed Oblique Flexed Oblique
Neutral <0.001* <0.001* <0.001* <0.001* <0.001* <0.001* 0.771 0.001*

Flexed - 0.134 - 0.203 - 0.029* - <0.001*

a. Adjustment for multiple comparisons: Bonferroni.
*. The mean difference is significant at the .05 level.

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